{"hospital_name":"Baytown Medical Center LP dba Baytown Medical Center","standard_charge_information":[{"description":"Declotting By Thrombolytic Agent Of Impl","code_information":[{"code":"2222645","type":"CDM"},{"code":"360","type":"RC"},{"code":"36593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":177250,"gross_charge":221562,"discounted_cash":221562,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177250}]}]},{"description":"Spinal fusion except cervical without MCC","code_information":[{"code":"CP17428476722283252","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"460","type":"DRG"}],"standard_charges":[{"setting":"inpatient","minimum":98535,"maximum":98535,"gross_charge":123169,"discounted_cash":123169,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98535},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98535},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98535}]}]},{"description":"Nevro Ipg2500","code_information":[{"code":"2800332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":94300,"maximum":94300,"gross_charge":117875,"discounted_cash":117875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94300}]}]},{"description":"Cervical spinal fusion without CC or MCC","code_information":[{"code":"CP17428476722286257","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"473","type":"DRG"}],"standard_charges":[{"setting":"inpatient","minimum":91972,"maximum":91972,"gross_charge":114965,"discounted_cash":114965,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91972},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91972},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91972}]}]},{"description":"Nevro Ipg Kit 2000","code_information":[{"code":"2800330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":89000,"maximum":89000,"gross_charge":111250,"discounted_cash":111250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89000}]}]},{"description":"Medtronic Intellis Adaptive Stim","code_information":[{"code":"2800292","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":82000,"maximum":82000,"gross_charge":102500,"discounted_cash":102500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82000}]}]},{"description":"Cardiac valve or cardiothoracic procedure with cardiac catheterization with MCC","code_information":[{"code":"CP17428476722284545","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"216","type":"DRG"}],"standard_charges":[{"setting":"inpatient","minimum":79558,"maximum":79558,"gross_charge":99448,"discounted_cash":99448,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79558}]}]},{"description":"Nevro Ipg Kit..","code_information":[{"code":"2800331","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":79000,"maximum":79000,"gross_charge":98750,"discounted_cash":98750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79000}]}]},{"description":"Major joint replacement or reattachment of lower extremity without MCC","code_information":[{"code":"CP17428476722285366","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"470","type":"DRG"}],"standard_charges":[{"setting":"inpatient","minimum":78554,"maximum":78554,"gross_charge":98193,"discounted_cash":98193,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78554}]}]},{"description":"B.s Spectra Wavewrtier Generator","code_information":[{"code":"2800119","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":76000,"maximum":76000,"gross_charge":95000,"discounted_cash":95000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76000}]}]},{"description":"Receiver And/or Transmitter, Neurostimul","code_information":[{"code":"28000268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":76000,"maximum":76000,"gross_charge":95000,"discounted_cash":95000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76000}]}]},{"description":"Removal of gallbladder using an endoscope","code_information":[{"code":"CP17428476722273422","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"47562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":70084,"gross_charge":87605,"discounted_cash":87605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70084}]}]},{"description":"Introduction Of Needle(s) And/or Cathete","code_information":[{"code":"28000750","type":"CDM"},{"code":"360","type":"RC"},{"code":"36903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":63714,"gross_charge":79642,"discounted_cash":79642,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63714},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63714},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63714}]}]},{"description":"Laminectomy, Facetectomy, Or Foraminotom","code_information":[{"code":"2221625","type":"CDM"},{"code":"360","type":"RC"},{"code":"63052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":60000,"gross_charge":75000,"discounted_cash":75000,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60000}]}]},{"description":"Xr Gastrointestinal Tract","code_information":[{"code":"5000145","type":"CDM"},{"code":"329","type":"RC"},{"code":"74246","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":56295,"maximum":56295,"gross_charge":70369,"discounted_cash":70369,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56295}]}]},{"description":"New Or Level 6 1st 30 Mins","code_information":[{"code":"12202992","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202992","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":54450,"maximum":54450,"gross_charge":68063,"discounted_cash":68063,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54450}]}]},{"description":"Ligation Or Banding Of Angioaccess Arter","code_information":[{"code":"28000754","type":"CDM"},{"code":"360","type":"RC"},{"code":"37607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":54450,"gross_charge":68063,"discounted_cash":68063,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54450}]}]},{"description":"Endovenous Femoral-popliteal Arterial Re","code_information":[{"code":"2222584","type":"CDM"},{"code":"360","type":"RC"},{"code":"0505T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52000,"maximum":52000,"gross_charge":65000,"discounted_cash":65000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52000}]}]},{"description":"Arteriovenous Anastomosis, Open; Direct,","code_information":[{"code":"2210151","type":"CDM"},{"code":"360","type":"RC"},{"code":"36821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":49722,"gross_charge":62153,"discounted_cash":62153,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49722},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49722},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49722}]}]},{"description":"New Or Level 5 1st 30 Mins","code_information":[{"code":"12202990","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202990","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49502,"maximum":49502,"gross_charge":61878,"discounted_cash":61878,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49502},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49502},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49502}]}]},{"description":"Ablation, Renal Tumor(s), Unilateral, Pe","code_information":[{"code":"22003292","type":"CDM"},{"code":"360","type":"RC"},{"code":"50593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2948,"maximum":47078,"gross_charge":58847,"discounted_cash":58847,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47078},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47078},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47078}]}]},{"description":"Repair of groin hernia patient age 5 years or older","code_information":[{"code":"CP17428476722276147","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"49505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":46084,"gross_charge":57605,"discounted_cash":57605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46084}]}]},{"description":"Optx Post Ankle Fx","code_information":[{"code":"2202031","type":"CDM"},{"code":"360","type":"RC"},{"code":"27769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":45861,"gross_charge":57326,"discounted_cash":57326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45861}]}]},{"description":"New Or Level 4 1st 30 Mins","code_information":[{"code":"12202984","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202984","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45861,"maximum":45861,"gross_charge":57326,"discounted_cash":57326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45861}]}]},{"description":"Angiography Adrenal Bil Slct Rad Sup&int","code_information":[{"code":"5000005","type":"CDM"},{"code":"329","type":"RC"},{"code":"75733","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Angiography Adrenal Uni Slct Rad Sup&int","code_information":[{"code":"5000006","type":"CDM"},{"code":"329","type":"RC"},{"code":"75731","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Angiography Brach Retrograde Rad Sup&int","code_information":[{"code":"5000007","type":"CDM"},{"code":"329","type":"RC"},{"code":"75658","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Angiography Pulm Bil Slct Rad Sup&int","code_information":[{"code":"5000012","type":"CDM"},{"code":"320","type":"RC"},{"code":"75743","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Angiography Pulm Uni Slct Rad Sup&int","code_information":[{"code":"5000014","type":"CDM"},{"code":"329","type":"RC"},{"code":"75741","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Aorto Thor W/o Serialography Rad Sup&int","code_information":[{"code":"5000021","type":"CDM"},{"code":"329","type":"RC"},{"code":"75600","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Percutaneous Transhepatic Portography","code_information":[{"code":"5000130","type":"CDM"},{"code":"320","type":"RC"},{"code":"75885","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Splenoportography Rad Sup&int","code_information":[{"code":"5000157","type":"CDM"},{"code":"320","type":"RC"},{"code":"75810","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Venography Adrenal Bilateral","code_information":[{"code":"5000198","type":"CDM"},{"code":"320","type":"RC"},{"code":"75842","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Veno Adrenal Uni Selective","code_information":[{"code":"5000199","type":"CDM"},{"code":"320","type":"RC"},{"code":"75840","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Veno Renal Bil Selective","code_information":[{"code":"5000206","type":"CDM"},{"code":"320","type":"RC"},{"code":"75833","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43527,"maximum":43527,"gross_charge":54409,"discounted_cash":54409,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43527}]}]},{"description":"Thrombolysis With Stent","code_information":[{"code":"22100128","type":"CDM"},{"code":"360","type":"RC"},{"code":"36906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":41225,"gross_charge":51531,"discounted_cash":51531,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41225},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41225},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41225}]}]},{"description":"Infusion Pump, Programmable (Implantable","code_information":[{"code":"28000736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":40400,"maximum":40400,"gross_charge":50500,"discounted_cash":50500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40400}]}]},{"description":"Revascularization, Endovascular, Open Or","code_information":[{"code":"2222689","type":"CDM"},{"code":"360","type":"RC"},{"code":"37228","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":40386,"gross_charge":50482,"discounted_cash":50482,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40386},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40386},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40386}]}]},{"description":"Vascular Embolization Or Occlusion, Incl","code_information":[{"code":"22100007","type":"CDM"},{"code":"360","type":"RC"},{"code":"37242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":40098,"gross_charge":50122,"discounted_cash":50122,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40098},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40098},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40098}]}]},{"description":"Arteriovenous Anastomosis, Open; By Uppe","code_information":[{"code":"2210146","type":"CDM"},{"code":"360","type":"RC"},{"code":"36819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":37698,"gross_charge":47123,"discounted_cash":47123,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37698}]}]},{"description":"Creation Of Arteriovenous Fistula By Oth","code_information":[{"code":"2210147","type":"CDM"},{"code":"360","type":"RC"},{"code":"36830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":37698,"gross_charge":47123,"discounted_cash":47123,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37698}]}]},{"description":"Insert Picvad Cath","code_information":[{"code":"2201561","type":"CDM"},{"code":"360","type":"RC"},{"code":"36571","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":37015,"gross_charge":46269,"discounted_cash":46269,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37015},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37015},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37015}]}]},{"description":"Tendon Shortening","code_information":[{"code":"2202653","type":"CDM"},{"code":"360","type":"RC"},{"code":"26477","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":37015,"gross_charge":46269,"discounted_cash":46269,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37015},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37015},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37015}]}]},{"description":"Incise Wrist/forearm Tendon","code_information":[{"code":"2202770","type":"CDM"},{"code":"360","type":"RC"},{"code":"25290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":37015,"gross_charge":46269,"discounted_cash":46269,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37015},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37015},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37015}]}]},{"description":"New Or Level 3 1st 30 Mins","code_information":[{"code":"12202982","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202982","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37015,"maximum":37015,"gross_charge":46269,"discounted_cash":46269,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37015},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37015},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37015}]}]},{"description":"Total Shoulder 2","code_information":[{"code":"2800679","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36616,"maximum":36616,"gross_charge":45770,"discounted_cash":45770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36616},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36616},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36616}]}]},{"description":"Axle 36mm Length Plate X 14mm Peek","code_information":[{"code":"2800115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36000,"maximum":36000,"gross_charge":45000,"discounted_cash":45000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36000}]}]},{"description":"X-spine 36mm Plate X 12mm Peek Insert","code_information":[{"code":"2800709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36000,"maximum":36000,"gross_charge":45000,"discounted_cash":45000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36000}]}]},{"description":"X-spine 55mm Length Plate X No Insert","code_information":[{"code":"2800710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36000,"maximum":36000,"gross_charge":45000,"discounted_cash":45000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36000}]}]},{"description":"Interlaminar Fusion Device","code_information":[{"code":"2810001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36000,"maximum":36000,"gross_charge":45000,"discounted_cash":45000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36000}]}]},{"description":"X-spine 36mm L Plate X 16mm Peek Insert","code_information":[{"code":"28007570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36000,"maximum":36000,"gross_charge":45000,"discounted_cash":45000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36000}]}]},{"description":"Hepatic Venography Wedged","code_information":[{"code":"5000087","type":"CDM"},{"code":"320","type":"RC"},{"code":"75891","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":35416,"maximum":35416,"gross_charge":44270,"discounted_cash":44270,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35416},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35416},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35416}]}]},{"description":"Venography Renal Unilateral","code_information":[{"code":"5000207","type":"CDM"},{"code":"320","type":"RC"},{"code":"75831","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":33358,"maximum":33358,"gross_charge":41698,"discounted_cash":41698,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33358},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33358},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33358}]}]},{"description":"Srs Linear Based","code_information":[{"code":"5000141","type":"CDM"},{"code":"320","type":"RC"},{"code":"77372","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":32032,"maximum":32032,"gross_charge":40040,"discounted_cash":40040,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32032}]}]},{"description":"Cn Implants","code_information":[{"code":"2802719","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32000,"maximum":32000,"gross_charge":40000,"discounted_cash":40000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32000}]}]},{"description":"Removal of tonsils and adenoid glands, patient younger than age 12","code_information":[{"code":"CP17428476722273593","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"42820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":30084,"gross_charge":37605,"discounted_cash":37605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30084}]}]},{"description":"Life Spine Prolift Lateral 18x45xlg","code_information":[{"code":"2800271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30000,"maximum":30000,"gross_charge":37500,"discounted_cash":37500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30000}]}]},{"description":"Life Spine Prolift Lateral 18x50 Lg","code_information":[{"code":"2800272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30000,"maximum":30000,"gross_charge":37500,"discounted_cash":37500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30000}]}]},{"description":"Aorto Abd+bil Iliofemoral Serialography","code_information":[{"code":"5000018","type":"CDM"},{"code":"329","type":"RC"},{"code":"75630","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":29532,"maximum":29532,"gross_charge":36915,"discounted_cash":36915,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29532},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29532},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29532}]}]},{"description":"Hepatic Venography Wedged","code_information":[{"code":"5000086","type":"CDM"},{"code":"320","type":"RC"},{"code":"75889","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":29532,"maximum":29532,"gross_charge":36915,"discounted_cash":36915,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29532},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29532},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29532}]}]},{"description":"Srs Multisource","code_information":[{"code":"5000142","type":"CDM"},{"code":"320","type":"RC"},{"code":"77371","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":28834,"maximum":28834,"gross_charge":36043,"discounted_cash":36043,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28834}]}]},{"description":"Stent, Coated/covered, With Delivery Sys","code_information":[{"code":"2810357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28000,"maximum":28000,"gross_charge":35000,"discounted_cash":35000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28000}]}]},{"description":"Laparoscopy, Surgical; With Revision Of","code_information":[{"code":"22002941","type":"CDM"},{"code":"360","type":"RC"},{"code":"49325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":26389,"gross_charge":32986,"discounted_cash":32986,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26389},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26389},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26389}]}]},{"description":"Removal of cataract with insertion of lens","code_information":[{"code":"CP17428476722287653","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"66984","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":26250,"gross_charge":32812,"discounted_cash":32812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26250}]}]},{"description":"Life Spine Prolift 15","code_information":[{"code":"2800270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26000,"maximum":26000,"gross_charge":32500,"discounted_cash":32500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26000}]}]},{"description":"Biopsy of prostate gland","code_information":[{"code":"CP17428476722275219","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":25861,"gross_charge":32326,"discounted_cash":32326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25861}]}]},{"description":"Angio Visc Selective Or Supra Selective","code_information":[{"code":"5000017","type":"CDM"},{"code":"329","type":"RC"},{"code":"75726","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":25810,"maximum":25810,"gross_charge":32262,"discounted_cash":32262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25810},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25810},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25810}]}]},{"description":"Aorto/ Serialography Thor Rad Sup&int","code_information":[{"code":"5000020","type":"CDM"},{"code":"329","type":"RC"},{"code":"75605","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":25352,"maximum":25352,"gross_charge":31690,"discounted_cash":31690,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25352},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25352},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25352}]}]},{"description":"Thrmbc/nfs Dialysis Circuit","code_information":[{"code":"2210143","type":"CDM"},{"code":"360","type":"RC"},{"code":"36905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":25156,"gross_charge":31445,"discounted_cash":31445,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25156}]}]},{"description":"Percutaneous Transluminal Mechanical Thr","code_information":[{"code":"28000756","type":"CDM"},{"code":"360","type":"RC"},{"code":"37187","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2948,"maximum":25156,"gross_charge":31445,"discounted_cash":31445,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25156}]}]},{"description":"Revision, Open, Arteriovenous Fistula; W","code_information":[{"code":"22000085","type":"CDM"},{"code":"360","type":"RC"},{"code":"36833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":25133,"gross_charge":31416,"discounted_cash":31416,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25133},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25133},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25133}]}]},{"description":"Or Level 7 1st 15min","code_information":[{"code":"2202994","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202994","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24862,"maximum":24862,"gross_charge":31077,"discounted_cash":31077,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24862}]}]},{"description":"Zimmer Mobi- C H6","code_information":[{"code":"28007572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24800,"maximum":24800,"gross_charge":31000,"discounted_cash":31000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24800}]}]},{"description":"Zimmer Mobi- C H5","code_information":[{"code":"28007573","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24800,"maximum":24800,"gross_charge":31000,"discounted_cash":31000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24800}]}]},{"description":"Implantable/insertable Device, Not Other","code_information":[{"code":"2810307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24600,"maximum":24600,"gross_charge":30750,"discounted_cash":30750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24600}]}]},{"description":"Dialysis Of Av Fistula","code_information":[{"code":"22100127","type":"CDM"},{"code":"360","type":"RC"},{"code":"36902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":24504,"gross_charge":30630,"discounted_cash":30630,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24504},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24504},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24504}]}]},{"description":"Spineart 14 Large 10 Cage","code_information":[{"code":"2800407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24000,"maximum":24000,"gross_charge":30000,"discounted_cash":30000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24000}]}]},{"description":"Spineart 14 Medium 10 Cage","code_information":[{"code":"2800408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24000,"maximum":24000,"gross_charge":30000,"discounted_cash":30000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24000}]}]},{"description":"Spineart 16 Large10 Cage","code_information":[{"code":"2800409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24000,"maximum":24000,"gross_charge":30000,"discounted_cash":30000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24000}]}]},{"description":"Spineart Large 15 16mm Cage","code_information":[{"code":"2800412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24000,"maximum":24000,"gross_charge":30000,"discounted_cash":30000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24000}]}]},{"description":"Spineart Medium H1415 Cage","code_information":[{"code":"2800413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24000,"maximum":24000,"gross_charge":30000,"discounted_cash":30000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24000}]}]},{"description":"Spineart Usa 12 Medium 15 Cage","code_information":[{"code":"2800414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24000,"maximum":24000,"gross_charge":30000,"discounted_cash":30000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24000}]}]},{"description":"Scarlet Lumbar Cage","code_information":[{"code":"2800779","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24000,"maximum":24000,"gross_charge":30000,"discounted_cash":30000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24000}]}]},{"description":"Angiography Spinal Slct Rad Sup&int","code_information":[{"code":"5000016","type":"CDM"},{"code":"329","type":"RC"},{"code":"75705","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":23153,"maximum":23153,"gross_charge":28941,"discounted_cash":28941,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23153}]}]},{"description":"Medtronic Kyphopak","code_information":[{"code":"2800293","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23096,"maximum":23096,"gross_charge":28870,"discounted_cash":28870,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23096}]}]},{"description":"Acumed Radial Head System","code_information":[{"code":"2800820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23096,"maximum":23096,"gross_charge":28870,"discounted_cash":28870,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23096}]}]},{"description":"Shaving of shoulder bone using endoscope","code_information":[{"code":"CP17428476722262607","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":23050,"gross_charge":28812,"discounted_cash":28812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23050},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23050},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23050}]}]},{"description":"Total Hip Implant","code_information":[{"code":"2800678","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22600,"maximum":22600,"gross_charge":28250,"discounted_cash":28250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22600}]}]},{"description":"Insertion of catheter into left heart for diagnosis","code_information":[{"code":"CP17428476722282970","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"93452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":22484,"gross_charge":28105,"discounted_cash":28105,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22484}]}]},{"description":"Catheter Placement In Coronary Artery(s)","code_information":[{"code":"22100011","type":"CDM"},{"code":"360","type":"RC"},{"code":"93458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":22354,"gross_charge":27943,"discounted_cash":27943,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22354},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22354},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22354}]}]},{"description":"Removal of one knee cartilage using an endoscope","code_information":[{"code":"CP17428476722271369","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":22084,"gross_charge":27605,"discounted_cash":27605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22084}]}]},{"description":"Ablation, 1 Or More Renal Tumor(s), Perc","code_information":[{"code":"22003293","type":"CDM"},{"code":"360","type":"RC"},{"code":"50592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":21990,"gross_charge":27488,"discounted_cash":27488,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21990},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21990},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21990}]}]},{"description":"Pet Body Skull To Thigh","code_information":[{"code":"5000138","type":"CDM"},{"code":"483","type":"RC"},{"code":"78815","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":950,"maximum":21866,"gross_charge":27332,"discounted_cash":27332,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21866},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21866},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21866},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Pet Body Skull To Feet","code_information":[{"code":"5000139","type":"CDM"},{"code":"404","type":"RC"},{"code":"78816","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":21866,"maximum":21866,"gross_charge":27332,"discounted_cash":27332,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21866},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21866},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21866}]}]},{"description":"Endoscopic Decompression Of Spinal Cord,","code_information":[{"code":"22000562","type":"CDM"},{"code":"360","type":"RC"},{"code":"62380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":21812,"gross_charge":27265,"discounted_cash":27265,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21812},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21812},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21812}]}]},{"description":"Percutaneous Transluminal Mechanical Thr","code_information":[{"code":"22223240","type":"CDM"},{"code":"360","type":"RC"},{"code":"36904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":21783,"gross_charge":27229,"discounted_cash":27229,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21783}]}]},{"description":"Uterine and adnexa procedures for non-malignancy without CC or MCC","code_information":[{"code":"CP17428476722288338","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"743","type":"DRG"}],"standard_charges":[{"setting":"inpatient","minimum":21337,"maximum":21337,"gross_charge":26671,"discounted_cash":26671,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21337}]}]},{"description":"Direct Repair Of Aneurysm, Pseudoaneurys","code_information":[{"code":"2220127","type":"CDM"},{"code":"360","type":"RC"},{"code":"35011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20944,"maximum":20944,"gross_charge":26180,"discounted_cash":26180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20944},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20944},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20944}]}]},{"description":"Dilation Nephrostomy Ureters Or Urethra","code_information":[{"code":"5000062","type":"CDM"},{"code":"329","type":"RC"},{"code":"74485","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":20858,"maximum":20858,"gross_charge":26073,"discounted_cash":26073,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20858},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20858},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20858}]}]},{"description":"Intro Cath Into Renal Pelvis For Drainag","code_information":[{"code":"5000096","type":"CDM"},{"code":"329","type":"RC"},{"code":"74475","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":20858,"maximum":20858,"gross_charge":26073,"discounted_cash":26073,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20858},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20858},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20858}]}]},{"description":"Intro Ureteral Cath Or Stent Into Ureter","code_information":[{"code":"5000098","type":"CDM"},{"code":"329","type":"RC"},{"code":"74480","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":20858,"maximum":20858,"gross_charge":26073,"discounted_cash":26073,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20858},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20858},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20858}]}]},{"description":"Orthofix  6mm Polycarbonate Urethane Tit","code_information":[{"code":"2800339","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20800,"maximum":20800,"gross_charge":26000,"discounted_cash":26000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20800}]}]},{"description":"Orthofix 6mm Polycarbonate Urethane Tita","code_information":[{"code":"2800341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20800,"maximum":20800,"gross_charge":26000,"discounted_cash":26000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20800}]}]},{"description":"Ant Instrument 2-3 Vertebral Seg 1st 15","code_information":[{"code":"2200062","type":"CDM"},{"code":"360","type":"RC"},{"code":"22845","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Ant Instrument 4-7 Vertebral Seg 1st 15","code_information":[{"code":"2200064","type":"CDM"},{"code":"360","type":"RC"},{"code":"22846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Ant Instrument =>8 Vertebral Seg 1st 15","code_information":[{"code":"2200066","type":"CDM"},{"code":"360","type":"RC"},{"code":"22847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Arthrodesis Sacroiliac Joint 1st","code_information":[{"code":"2200115","type":"CDM"},{"code":"360","type":"RC"},{"code":"27279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Neck Spine Fusion 1st","code_information":[{"code":"2200119","type":"CDM"},{"code":"360","type":"RC"},{"code":"22554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Arthrodesis Anterior Interbody Tech 1st","code_information":[{"code":"2200121","type":"CDM"},{"code":"360","type":"RC"},{"code":"22585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20718,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Lumbar Spine Fusion 1st","code_information":[{"code":"2200123","type":"CDM"},{"code":"360","type":"RC"},{"code":"22558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Thorax Spine Fusion 1st","code_information":[{"code":"2200125","type":"CDM"},{"code":"360","type":"RC"},{"code":"22556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Neck Spine Fuse&remov Bel C2 1st","code_information":[{"code":"2200127","type":"CDM"},{"code":"360","type":"RC"},{"code":"22551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Arthrodesis Anterior Interbody Disc 1st","code_information":[{"code":"2200129","type":"CDM"},{"code":"360","type":"RC"},{"code":"22552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Arthrodesis Combined Posterior Tech 1st","code_information":[{"code":"2200132","type":"CDM"},{"code":"360","type":"RC"},{"code":"22634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Lumbar Spine Fusion Combined 1st","code_information":[{"code":"2200134","type":"CDM"},{"code":"360","type":"RC"},{"code":"22633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Lat Thorax Spine Fusion 1st","code_information":[{"code":"2200144","type":"CDM"},{"code":"360","type":"RC"},{"code":"22532","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Arthrodesis Lat Extracavitary Technique","code_information":[{"code":"2200146","type":"CDM"},{"code":"360","type":"RC"},{"code":"22534","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Arthrodesis Posterior Interbody Techniqu","code_information":[{"code":"2200154","type":"CDM"},{"code":"360","type":"RC"},{"code":"22632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Lumbar Spine Fusion 1st","code_information":[{"code":"2200156","type":"CDM"},{"code":"360","type":"RC"},{"code":"22630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Neck Spine Fusion 1st","code_information":[{"code":"2200158","type":"CDM"},{"code":"360","type":"RC"},{"code":"22600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Arthrodesis Post Or Posterolat Tech 1st","code_information":[{"code":"2200160","type":"CDM"},{"code":"360","type":"RC"},{"code":"22614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Lumbar Spine Fusion 1st","code_information":[{"code":"2200162","type":"CDM"},{"code":"360","type":"RC"},{"code":"22612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Thorax Spine Fusion 1st","code_information":[{"code":"2200164","type":"CDM"},{"code":"360","type":"RC"},{"code":"22610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Post Fusion 7-12 Vert Seg 1st","code_information":[{"code":"2200166","type":"CDM"},{"code":"360","type":"RC"},{"code":"22802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Fusion Of Sacroiliac Joint 1st","code_information":[{"code":"2200169","type":"CDM"},{"code":"360","type":"RC"},{"code":"27280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Total Hip Arthroplasty 1st","code_information":[{"code":"2200181","type":"CDM"},{"code":"360","type":"RC"},{"code":"27130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Exploration Spinal Fusion 1st","code_information":[{"code":"2201247","type":"CDM"},{"code":"360","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Insertion Interbody Biomechanical Device","code_information":[{"code":"2201546","type":"CDM"},{"code":"360","type":"RC"},{"code":"22853","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Ins Intervertebral Miomechanical Device","code_information":[{"code":"2201548","type":"CDM"},{"code":"360","type":"RC"},{"code":"22854","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Lamin/facet&foramin Sgl Vrtbrl Sgmt Lumb","code_information":[{"code":"2201594","type":"CDM"},{"code":"360","type":"RC"},{"code":"63047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Excise Intrspinl Lesion Lmbr 1st","code_information":[{"code":"2201598","type":"CDM"},{"code":"360","type":"RC"},{"code":"63267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Implant Neuroelectrodes 1st","code_information":[{"code":"2201600","type":"CDM"},{"code":"360","type":"RC"},{"code":"63655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Remove Lamina/facets Lumbar 1st","code_information":[{"code":"2201602","type":"CDM"},{"code":"360","type":"RC"},{"code":"63012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Remove Spine Lamina 1 Crvl 1st","code_information":[{"code":"2201604","type":"CDM"},{"code":"360","type":"RC"},{"code":"63045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Laminectomy Facetectomy And Foraminotomy","code_information":[{"code":"2201606","type":"CDM"},{"code":"360","type":"RC"},{"code":"63048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Remove Spine Lamina 1 Thrc 1st","code_information":[{"code":"2201608","type":"CDM"},{"code":"360","type":"RC"},{"code":"63046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"C-laminoplasty W/graft/plate 1st","code_information":[{"code":"2201612","type":"CDM"},{"code":"360","type":"RC"},{"code":"63051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20718,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Laminotomy Single Cervical 1st","code_information":[{"code":"2201614","type":"CDM"},{"code":"360","type":"RC"},{"code":"63040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Laminotomy Single Ea Add Cervical 1st","code_information":[{"code":"2201616","type":"CDM"},{"code":"360","type":"RC"},{"code":"63043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Laminotomy Single Ea Add Lumbar 1st","code_information":[{"code":"2201618","type":"CDM"},{"code":"360","type":"RC"},{"code":"63044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Laminotomy Single Lumbar 1st","code_information":[{"code":"2201620","type":"CDM"},{"code":"360","type":"RC"},{"code":"63042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Laminotomy Single Cervical/lumbar 1st","code_information":[{"code":"2201622","type":"CDM"},{"code":"360","type":"RC"},{"code":"63035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Neck Spine Disk Surgery 1st","code_information":[{"code":"2201624","type":"CDM"},{"code":"360","type":"RC"},{"code":"63020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Low Back Disk Surgery 1st","code_information":[{"code":"2201626","type":"CDM"},{"code":"360","type":"RC"},{"code":"63030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Pelvic Fixation Attachment Caudal End  1","code_information":[{"code":"2202168","type":"CDM"},{"code":"360","type":"RC"},{"code":"22848","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Implant Neuroelectrodes 1st","code_information":[{"code":"2202170","type":"CDM"},{"code":"360","type":"RC"},{"code":"63650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Implant Neuroelectrodes 1st","code_information":[{"code":"2202174","type":"CDM"},{"code":"360","type":"RC"},{"code":"64561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Perq Lamot/lam Lumbar 1st","code_information":[{"code":"2202176","type":"CDM"},{"code":"360","type":"RC"},{"code":"0275T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20718,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Perq Vertebral Augmentation Lu 1st","code_information":[{"code":"2202206","type":"CDM"},{"code":"360","type":"RC"},{"code":"22514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Perq Vertebral Augmentation Th 1st","code_information":[{"code":"2202208","type":"CDM"},{"code":"360","type":"RC"},{"code":"22513","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Perc Vertebroplasty Bone Biopsy  1st","code_information":[{"code":"2202214","type":"CDM"},{"code":"360","type":"RC"},{"code":"22512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Perq Lumbosacral Injection 1st","code_information":[{"code":"2202216","type":"CDM"},{"code":"360","type":"RC"},{"code":"22511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Post Nonsegmental Instr Eg Harrington 1s","code_information":[{"code":"2202244","type":"CDM"},{"code":"360","type":"RC"},{"code":"22840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Posterior Segmental Instrumentation 1st","code_information":[{"code":"2202246","type":"CDM"},{"code":"360","type":"RC"},{"code":"22844","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Posterior Segmental Instrumentation 1st","code_information":[{"code":"2202248","type":"CDM"},{"code":"360","type":"RC"},{"code":"22842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Reinsertion Spinal Fixation Device 1st","code_information":[{"code":"2202323","type":"CDM"},{"code":"360","type":"RC"},{"code":"22849","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Removal Anterior Instrumentation 1st","code_information":[{"code":"2202351","type":"CDM"},{"code":"360","type":"RC"},{"code":"22855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Remove Spine Fixation Device 1st","code_information":[{"code":"2202382","type":"CDM"},{"code":"360","type":"RC"},{"code":"22850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Remove Spine Eltrd Plate 1st","code_information":[{"code":"2202398","type":"CDM"},{"code":"360","type":"RC"},{"code":"63662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Revise Cerv Artific Disc 1st","code_information":[{"code":"2202598","type":"CDM"},{"code":"360","type":"RC"},{"code":"22861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Revise Spine Eltrd Perq Aray 1st","code_information":[{"code":"2202600","type":"CDM"},{"code":"360","type":"RC"},{"code":"63663","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Revise Spine Eltrd Plate 1st","code_information":[{"code":"2202602","type":"CDM"},{"code":"360","type":"RC"},{"code":"63664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Revise Hip Joint Replacement 1st","code_information":[{"code":"2202610","type":"CDM"},{"code":"360","type":"RC"},{"code":"27134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Revise Hip Joint Replacement 1st","code_information":[{"code":"2202612","type":"CDM"},{"code":"360","type":"RC"},{"code":"27138","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Revise/remove Neuroreceiver 1st","code_information":[{"code":"2202620","type":"CDM"},{"code":"360","type":"RC"},{"code":"63688","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Tot Disc Arthroplasty Anterior Approach","code_information":[{"code":"2202812","type":"CDM"},{"code":"360","type":"RC"},{"code":"22858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Cerv Artific Diskectomy 1st","code_information":[{"code":"2202814","type":"CDM"},{"code":"360","type":"RC"},{"code":"22856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Lumbar Artif Diskectomy 1st","code_information":[{"code":"2202818","type":"CDM"},{"code":"360","type":"RC"},{"code":"22857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Transped Appr W Decompression Spinal Cr","code_information":[{"code":"2202836","type":"CDM"},{"code":"360","type":"RC"},{"code":"63057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Decompress Spinal Cord Lmbr 1st","code_information":[{"code":"2202838","type":"CDM"},{"code":"360","type":"RC"},{"code":"63056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Or Level 6 1st 15min","code_information":[{"code":"2202992","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202992","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20718,"maximum":20718,"gross_charge":25897,"discounted_cash":25897,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20718}]}]},{"description":"Knee Total Implant","code_information":[{"code":"2800257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20000,"maximum":20000,"gross_charge":25000,"discounted_cash":25000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20000}]}]},{"description":"Sbrt Delivery","code_information":[{"code":"5000158","type":"CDM"},{"code":"320","type":"RC"},{"code":"77373","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":19501,"maximum":19501,"gross_charge":24376,"discounted_cash":24376,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19501},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19501},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19501}]}]},{"description":"Removal of one or more breast growth, open procedure","code_information":[{"code":"CP17428476722254138","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"19120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":19474,"gross_charge":24342,"discounted_cash":24342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19474}]}]},{"description":"Stryker 4x8cm Allowrap Ds Wet","code_information":[{"code":"2800442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19456,"maximum":19456,"gross_charge":24320,"discounted_cash":24320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19456},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19456},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19456}]}]},{"description":"Card Mri W/stress Img & Dye","code_information":[{"code":"5300002","type":"CDM"},{"code":"360","type":"RC"},{"code":"75563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19389,"maximum":19389,"gross_charge":24236,"discounted_cash":24236,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19389},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19389},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19389}]}]},{"description":"Arthroplasty Ankle W/implant 1st 15","code_information":[{"code":"2200183","type":"CDM"},{"code":"360","type":"RC"},{"code":"27702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Reconstruct Shoulder Joint 1st","code_information":[{"code":"2200187","type":"CDM"},{"code":"360","type":"RC"},{"code":"23472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Total Knee Arthroplasty 1st","code_information":[{"code":"2200195","type":"CDM"},{"code":"360","type":"RC"},{"code":"27447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Revision Of Knee Joint 1st","code_information":[{"code":"2200197","type":"CDM"},{"code":"360","type":"RC"},{"code":"27446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Percutaneous Diskectomy 1st","code_information":[{"code":"2200324","type":"CDM"},{"code":"360","type":"RC"},{"code":"62287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Total Hip Arthroplasty 1st","code_information":[{"code":"2200602","type":"CDM"},{"code":"360","type":"RC"},{"code":"27132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Decompression Unspecified Nerves Specify","code_information":[{"code":"2200767","type":"CDM"},{"code":"360","type":"RC"},{"code":"64722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Donor Pancreatectomy Inc Cold Preserv 1s","code_information":[{"code":"2200828","type":"CDM"},{"code":"360","type":"RC"},{"code":"48550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Partial Hip Replacement 1st","code_information":[{"code":"2201327","type":"CDM"},{"code":"360","type":"RC"},{"code":"27125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Implant Spinal Canal Cath 1st","code_information":[{"code":"2201374","type":"CDM"},{"code":"360","type":"RC"},{"code":"62350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Insert Self-contd Prosthesis 1st","code_information":[{"code":"2201560","type":"CDM"},{"code":"360","type":"RC"},{"code":"54400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Bx/exc Xdrl Spine Lesn Lmbr 1st","code_information":[{"code":"2201596","type":"CDM"},{"code":"360","type":"RC"},{"code":"63277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Cervical Laminoplsty 2/> Seg 1st","code_information":[{"code":"2201610","type":"CDM"},{"code":"360","type":"RC"},{"code":"63050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Diag Laparo Separate Proc 1st","code_information":[{"code":"2201638","type":"CDM"},{"code":"360","type":"RC"},{"code":"49320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Implant Neuroelectrodes 1st","code_information":[{"code":"2202172","type":"CDM"},{"code":"360","type":"RC"},{"code":"64555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Perq Vertebral Augmentation 1st","code_information":[{"code":"2202204","type":"CDM"},{"code":"360","type":"RC"},{"code":"22515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Perq Vertebral Augmentation Th 1st","code_information":[{"code":"2202212","type":"CDM"},{"code":"360","type":"RC"},{"code":"22523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Repair Of Shoulder 1st","code_information":[{"code":"2202303","type":"CDM"},{"code":"360","type":"RC"},{"code":"23420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Repair Of Ruptured Tendon 1st","code_information":[{"code":"2202321","type":"CDM"},{"code":"360","type":"RC"},{"code":"24342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Remove Spinal Canal Catheter 1st","code_information":[{"code":"2202386","type":"CDM"},{"code":"360","type":"RC"},{"code":"62355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Remove Spine Eltrd Perq Aray 1st","code_information":[{"code":"2202396","type":"CDM"},{"code":"360","type":"RC"},{"code":"63661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Rerepair Ventrl Hern Block 1st","code_information":[{"code":"2202503","type":"CDM"},{"code":"360","type":"RC"},{"code":"49566","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Revise/replace Knee Joint 1st","code_information":[{"code":"2202614","type":"CDM"},{"code":"360","type":"RC"},{"code":"27487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Revis Reconst Shoulder Joint 1st","code_information":[{"code":"2202618","type":"CDM"},{"code":"360","type":"RC"},{"code":"23473","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Total Disc Arthroplasty Anterior Approac","code_information":[{"code":"2202816","type":"CDM"},{"code":"360","type":"RC"},{"code":"0163T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Vertebral Corpectomy Vertebral Body Res","code_information":[{"code":"2202965","type":"CDM"},{"code":"360","type":"RC"},{"code":"63082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Remove Vert Body Dcmprn Crvl 1st","code_information":[{"code":"2202967","type":"CDM"},{"code":"360","type":"RC"},{"code":"63081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Vertebr Corpectomy Vertebral Body Resect","code_information":[{"code":"2202969","type":"CDM"},{"code":"360","type":"RC"},{"code":"63088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Remov Vertbr Dcmprn Thrclmbr 1st","code_information":[{"code":"2202971","type":"CDM"},{"code":"360","type":"RC"},{"code":"63087","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Vertebral Corpectomy Vertebral Body Rese","code_information":[{"code":"2202973","type":"CDM"},{"code":"360","type":"RC"},{"code":"63103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Remove Vert Body Dcmprn Thrc 1st","code_information":[{"code":"2202975","type":"CDM"},{"code":"360","type":"RC"},{"code":"63101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Remove Vert Body Dcmprn Lmbr 1st","code_information":[{"code":"2202977","type":"CDM"},{"code":"360","type":"RC"},{"code":"63090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Or Level 5 1st 15min","code_information":[{"code":"2202990","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202990","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18835,"maximum":18835,"gross_charge":23544,"discounted_cash":23544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18835}]}]},{"description":"Angiography Ext Uni Rad Sup&int","code_information":[{"code":"5000009","type":"CDM"},{"code":"329","type":"RC"},{"code":"75710","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":18796,"maximum":18796,"gross_charge":23495,"discounted_cash":23495,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18796}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"CP17428476722272342","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":18676,"gross_charge":23345,"discounted_cash":23345,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18676}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"CP17428476722277181","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":18676,"gross_charge":23345,"discounted_cash":23345,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18676}]}]},{"description":"Ultrasound examination of lower large bowel using an endoscope","code_information":[{"code":"CP17428476722272619","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":18676,"gross_charge":23345,"discounted_cash":23345,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18676}]}]},{"description":"S&n Warth Del","code_information":[{"code":"2800790","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18492,"maximum":18492,"gross_charge":23115,"discounted_cash":23115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18492},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18492},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18492}]}]},{"description":"Venous Sampling Throu Cath W/wo Angio","code_information":[{"code":"5000210","type":"CDM"},{"code":"320","type":"RC"},{"code":"75893","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":18404,"maximum":18404,"gross_charge":23005,"discounted_cash":23005,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18404}]}]},{"description":"Life Sciences Cervical Hive C Interbody","code_information":[{"code":"2800261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18000,"maximum":18000,"gross_charge":22500,"discounted_cash":22500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18000}]}]},{"description":"Life Sciences Interbody Spacer With Nano","code_information":[{"code":"2800262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18000,"maximum":18000,"gross_charge":22500,"discounted_cash":22500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18000}]}]},{"description":"Synthes Jj 4.5 Va -Lcp Curved Plate","code_information":[{"code":"2800628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17896,"maximum":17896,"gross_charge":22370,"discounted_cash":22370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17896},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17896},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17896}]}]},{"description":"Mimedx Epifix 6x10cm","code_information":[{"code":"2800312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17580,"maximum":17580,"gross_charge":21975,"discounted_cash":21975,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17580},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17580},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17580}]}]},{"description":"Amputation Foot Transmetatarsal 1st 15 M","code_information":[{"code":"2200044","type":"CDM"},{"code":"360","type":"RC"},{"code":"28805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Ant Vesicoure/urethropexy Smp 1st 15 Min","code_information":[{"code":"2200070","type":"CDM"},{"code":"360","type":"RC"},{"code":"51840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Arthrodesis Ankle Open 1st 15 Min","code_information":[{"code":"2200117","type":"CDM"},{"code":"360","type":"RC"},{"code":"27870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Fusion Of Foot Bones 1st","code_information":[{"code":"2200148","type":"CDM"},{"code":"360","type":"RC"},{"code":"28730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Reconstruct Shoulder Joint 1st","code_information":[{"code":"2200185","type":"CDM"},{"code":"360","type":"RC"},{"code":"23470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Arthroplasty Ipj Each Joint 1st","code_information":[{"code":"2200189","type":"CDM"},{"code":"360","type":"RC"},{"code":"26535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Wrist Joints 1st","code_information":[{"code":"2200193","type":"CDM"},{"code":"360","type":"RC"},{"code":"25447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Revise Knuckle With Implant 1st","code_information":[{"code":"2200201","type":"CDM"},{"code":"360","type":"RC"},{"code":"26531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200204","type":"CDM"},{"code":"360","type":"RC"},{"code":"29888","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Shoulder Arthroscopy Dx 1st","code_information":[{"code":"2200256","type":"CDM"},{"code":"360","type":"RC"},{"code":"29805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Arthroscopy Shldr/bicep Tenodesis 1st","code_information":[{"code":"2200258","type":"CDM"},{"code":"360","type":"RC"},{"code":"29828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Arthroscopy Shldr Capsulorrhaphy 1st","code_information":[{"code":"2200260","type":"CDM"},{"code":"360","type":"RC"},{"code":"29806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Shaving of shoulder bone using endoscope","code_information":[{"code":"2200266","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Shoulder Arthroscopy/surgery 1st","code_information":[{"code":"2200268","type":"CDM"},{"code":"360","type":"RC"},{"code":"29824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Arthroscopy Shoulder Rep Slap Lesion 1st","code_information":[{"code":"2200270","type":"CDM"},{"code":"360","type":"RC"},{"code":"29807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Arthroscopy Shldr W/rot Cuff Repair 1st","code_information":[{"code":"2200278","type":"CDM"},{"code":"360","type":"RC"},{"code":"29827","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Revision Of Lower Eyelid 1st","code_information":[{"code":"2200399","type":"CDM"},{"code":"360","type":"RC"},{"code":"15821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Blepharoplasty Upper Eyelid 1st","code_information":[{"code":"2200401","type":"CDM"},{"code":"360","type":"RC"},{"code":"15822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Revision Of Upper Eyelid 1st","code_information":[{"code":"2200403","type":"CDM"},{"code":"360","type":"RC"},{"code":"15823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Bunionectomy W/proximal Metarsal Osteoto","code_information":[{"code":"2200426","type":"CDM"},{"code":"360","type":"RC"},{"code":"28295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Removal Of Gallbladder 1st","code_information":[{"code":"2200470","type":"CDM"},{"code":"360","type":"RC"},{"code":"47612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Cholecystectomy 1st","code_information":[{"code":"2200472","type":"CDM"},{"code":"360","type":"RC"},{"code":"47600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Correction Hallux Valgus 1st","code_information":[{"code":"2200611","type":"CDM"},{"code":"360","type":"RC"},{"code":"28299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Correction Hallux Valgus 1st","code_information":[{"code":"2200615","type":"CDM"},{"code":"360","type":"RC"},{"code":"28292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Correction Hallux Valgus 1st","code_information":[{"code":"2200617","type":"CDM"},{"code":"360","type":"RC"},{"code":"28297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Correction Hallux Valgus 1st","code_information":[{"code":"2200619","type":"CDM"},{"code":"360","type":"RC"},{"code":"28296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Of Hammertoe 1st","code_information":[{"code":"2200621","type":"CDM"},{"code":"360","type":"RC"},{"code":"28285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200631","type":"CDM"},{"code":"360","type":"RC"},{"code":"52320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200679","type":"CDM"},{"code":"360","type":"RC"},{"code":"52332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Cystourethroscopy W/urethral Stnt 1st","code_information":[{"code":"2200681","type":"CDM"},{"code":"360","type":"RC"},{"code":"52282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Destruction Penis Lesion(s) 1st","code_information":[{"code":"2200795","type":"CDM"},{"code":"360","type":"RC"},{"code":"54065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Destroy Vulva Lesions Sim 1st","code_information":[{"code":"2200805","type":"CDM"},{"code":"360","type":"RC"},{"code":"56501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Endovascular Repair The Iliac Artery 1st","code_information":[{"code":"2200886","type":"CDM"},{"code":"360","type":"RC"},{"code":"34718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Removal Of Intranasal Lesion 1st","code_information":[{"code":"2201058","type":"CDM"},{"code":"360","type":"RC"},{"code":"30117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Removal of cataract with insertion of lens","code_information":[{"code":"2201256","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"66984","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Xcapsl Ctrc Rmvl Cplx Wo Ecp 1st","code_information":[{"code":"2201258","type":"CDM"},{"code":"360","type":"RC"},{"code":"66982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Removal Of Stomach Partial 1st","code_information":[{"code":"2201301","type":"CDM"},{"code":"360","type":"RC"},{"code":"43632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Removal Of Stomach Partial 1st","code_information":[{"code":"2201303","type":"CDM"},{"code":"360","type":"RC"},{"code":"43633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Removal Of Stomach 1st","code_information":[{"code":"2201305","type":"CDM"},{"code":"360","type":"RC"},{"code":"43621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Mesh Implant Incis/ventral Hernia Rep 1s","code_information":[{"code":"2201370","type":"CDM"},{"code":"360","type":"RC"},{"code":"49568","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Implant Spine Infusion Pump 1st","code_information":[{"code":"2201372","type":"CDM"},{"code":"360","type":"RC"},{"code":"62362","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Insert Self-contd Prosthesis 1st","code_information":[{"code":"2201558","type":"CDM"},{"code":"360","type":"RC"},{"code":"54401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Insrt/redo Pn/gastr Stimul 1st","code_information":[{"code":"2201577","type":"CDM"},{"code":"360","type":"RC"},{"code":"64590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Insrt/redo Spine N Generator 1st","code_information":[{"code":"2201579","type":"CDM"},{"code":"360","type":"RC"},{"code":"63685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Laparoscopy Appendectomy 1st","code_information":[{"code":"2201640","type":"CDM"},{"code":"360","type":"RC"},{"code":"44970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Sleeve Gastrectomy 1st","code_information":[{"code":"2201648","type":"CDM"},{"code":"360","type":"RC"},{"code":"43775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Place Gastr Adj Device 1st","code_information":[{"code":"2201650","type":"CDM"},{"code":"360","type":"RC"},{"code":"43770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Replace Gastr Adj Device 1st","code_information":[{"code":"2201652","type":"CDM"},{"code":"360","type":"RC"},{"code":"43773","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Rmvl Gastr Adj All Parts 1st","code_information":[{"code":"2201654","type":"CDM"},{"code":"360","type":"RC"},{"code":"43774","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Revise Gastr Adj Device 1st","code_information":[{"code":"2201656","type":"CDM"},{"code":"360","type":"RC"},{"code":"43771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Inc Hernia Repair 1st","code_information":[{"code":"2201668","type":"CDM"},{"code":"360","type":"RC"},{"code":"49654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Vent/abd Hern Proc Comp 1st","code_information":[{"code":"2201670","type":"CDM"},{"code":"360","type":"RC"},{"code":"49653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Laparo-asst Vag Hysterectomy 1st","code_information":[{"code":"2201692","type":"CDM"},{"code":"360","type":"RC"},{"code":"58550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Laparo-vag Hyst Complex 1st","code_information":[{"code":"2201694","type":"CDM"},{"code":"360","type":"RC"},{"code":"58553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Laparo-vag Hyst W/t/o Compl 1st","code_information":[{"code":"2201696","type":"CDM"},{"code":"360","type":"RC"},{"code":"58554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Ing Hernia Repair Init 1st","code_information":[{"code":"2201710","type":"CDM"},{"code":"360","type":"RC"},{"code":"49650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Lap Ing Hernia Repair Recur 1st","code_information":[{"code":"2201712","type":"CDM"},{"code":"360","type":"RC"},{"code":"49651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Laser Surgery Of Prostate 1st","code_information":[{"code":"2201749","type":"CDM"},{"code":"360","type":"RC"},{"code":"52647","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Laser Surgery Of Prostate 1st","code_information":[{"code":"2201751","type":"CDM"},{"code":"360","type":"RC"},{"code":"52648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Remove Bladder Stone Smpl 1st","code_information":[{"code":"2201791","type":"CDM"},{"code":"360","type":"RC"},{"code":"52317","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Nsl/sins Ndsc Total 1st","code_information":[{"code":"2201862","type":"CDM"},{"code":"360","type":"RC"},{"code":"31253","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Nsl/sins Ndsc Tot W/sphendt 1st","code_information":[{"code":"2201864","type":"CDM"},{"code":"360","type":"RC"},{"code":"31257","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Nsl/sins Ndsc Sphn Tiss Rmvl 1st","code_information":[{"code":"2201866","type":"CDM"},{"code":"360","type":"RC"},{"code":"31259","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Nsl/sins Ndsc Surg Frnt&sphn 1st","code_information":[{"code":"2201868","type":"CDM"},{"code":"360","type":"RC"},{"code":"31298","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Nsl/sins Ndsc Surg Frnt Sins 1st","code_information":[{"code":"2201893","type":"CDM"},{"code":"360","type":"RC"},{"code":"31296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Nsl/sins Ndsc Surg Sphn Sins 1st","code_information":[{"code":"2201897","type":"CDM"},{"code":"360","type":"RC"},{"code":"31297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treatment Of Ankle Fracture 1st","code_information":[{"code":"2201953","type":"CDM"},{"code":"360","type":"RC"},{"code":"27814","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treatment Of Ankle Fracture 1st","code_information":[{"code":"2201965","type":"CDM"},{"code":"360","type":"RC"},{"code":"27792","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treatment Of Thigh Fracture 1st","code_information":[{"code":"2201981","type":"CDM"},{"code":"360","type":"RC"},{"code":"27507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Big Toe Fracture 1st","code_information":[{"code":"2201991","type":"CDM"},{"code":"360","type":"RC"},{"code":"28505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Toe Fracture 1st","code_information":[{"code":"2201993","type":"CDM"},{"code":"360","type":"RC"},{"code":"28525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Humerus Fracture 1st","code_information":[{"code":"2201995","type":"CDM"},{"code":"360","type":"RC"},{"code":"23630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Humerus Fracture 1st","code_information":[{"code":"2202003","type":"CDM"},{"code":"360","type":"RC"},{"code":"24515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Of Toe Dislocation 1st","code_information":[{"code":"2202009","type":"CDM"},{"code":"360","type":"RC"},{"code":"28675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Optx Medial Ankle Fx 1st","code_information":[{"code":"2202015","type":"CDM"},{"code":"360","type":"RC"},{"code":"27766","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Metacarpal Fracture 1st","code_information":[{"code":"2202017","type":"CDM"},{"code":"360","type":"RC"},{"code":"26615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Metatarsal Fracture 1st","code_information":[{"code":"2202019","type":"CDM"},{"code":"360","type":"RC"},{"code":"28485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Toe Dislocation 1st","code_information":[{"code":"2202021","type":"CDM"},{"code":"360","type":"RC"},{"code":"28645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Finger Fracture Each 1st","code_information":[{"code":"2202030","type":"CDM"},{"code":"360","type":"RC"},{"code":"26735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Humerus Fracture 1st","code_information":[{"code":"2202033","type":"CDM"},{"code":"360","type":"RC"},{"code":"23615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Fracture Of Radius 1st","code_information":[{"code":"2202043","type":"CDM"},{"code":"360","type":"RC"},{"code":"25515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Sesamoid Bone Fracture 1st","code_information":[{"code":"2202047","type":"CDM"},{"code":"360","type":"RC"},{"code":"28531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treatment Of Tibia Fracture 1st","code_information":[{"code":"2202059","type":"CDM"},{"code":"360","type":"RC"},{"code":"27758","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treatment Of Ankle Fracture 1st","code_information":[{"code":"2202061","type":"CDM"},{"code":"360","type":"RC"},{"code":"27823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Revise Eye Socket Implant 1st","code_information":[{"code":"2202075","type":"CDM"},{"code":"360","type":"RC"},{"code":"67560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Osteotomy Spine Post Approach 1 Vertebra","code_information":[{"code":"2202097","type":"CDM"},{"code":"360","type":"RC"},{"code":"22216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Incis 1 Vertebral Seg Thorac 1st","code_information":[{"code":"2202100","type":"CDM"},{"code":"360","type":"RC"},{"code":"22212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Osteotomy Spine Post Approach 3 Column 1","code_information":[{"code":"2202102","type":"CDM"},{"code":"360","type":"RC"},{"code":"22208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Incis Spine 3 Column Lumbar 1st","code_information":[{"code":"2202104","type":"CDM"},{"code":"360","type":"RC"},{"code":"22207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Incis Spine 3 Column Thorac 1st","code_information":[{"code":"2202106","type":"CDM"},{"code":"360","type":"RC"},{"code":"22206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Incision Of Metatarsal 1st","code_information":[{"code":"2202118","type":"CDM"},{"code":"360","type":"RC"},{"code":"28306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Incision Of Metatarsal 1st","code_information":[{"code":"2202120","type":"CDM"},{"code":"360","type":"RC"},{"code":"28308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Incision Of Heel Bone 1st","code_information":[{"code":"2202122","type":"CDM"},{"code":"360","type":"RC"},{"code":"28300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Treat Finger Fracture Each 1st","code_information":[{"code":"2202202","type":"CDM"},{"code":"360","type":"RC"},{"code":"26727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Remove Spine Fixation Device 1st","code_information":[{"code":"2202384","type":"CDM"},{"code":"360","type":"RC"},{"code":"22852","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Remove Spine Infusion Device 1st","code_information":[{"code":"2202400","type":"CDM"},{"code":"360","type":"RC"},{"code":"62365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Removal Tunneled Cv Cath 1st","code_information":[{"code":"2202407","type":"CDM"},{"code":"360","type":"RC"},{"code":"36590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Revise/remove Sling Repair 1st","code_information":[{"code":"2202413","type":"CDM"},{"code":"360","type":"RC"},{"code":"57287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repr Elbow Lat Ligmnt W/tiss 1st","code_information":[{"code":"2202435","type":"CDM"},{"code":"360","type":"RC"},{"code":"24343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Spinal Fluid Leakage 1st","code_information":[{"code":"2202457","type":"CDM"},{"code":"360","type":"RC"},{"code":"63709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Nasal Stenosis 1st","code_information":[{"code":"2202477","type":"CDM"},{"code":"360","type":"RC"},{"code":"30465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Rotator Cuff Chronic 1st","code_information":[{"code":"2202487","type":"CDM"},{"code":"360","type":"RC"},{"code":"23412","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Finger/hand Tendon 1st","code_information":[{"code":"2202493","type":"CDM"},{"code":"360","type":"RC"},{"code":"26356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair/graft Hand Tendon 1st","code_information":[{"code":"2202495","type":"CDM"},{"code":"360","type":"RC"},{"code":"26358","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Lower Leg Tendons 1st","code_information":[{"code":"2202533","type":"CDM"},{"code":"360","type":"RC"},{"code":"27676","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Lower Leg Tendons 1st","code_information":[{"code":"2202535","type":"CDM"},{"code":"360","type":"RC"},{"code":"27675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Of Ankle Ligament 1st","code_information":[{"code":"2202559","type":"CDM"},{"code":"360","type":"RC"},{"code":"27695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Achilles Tendon 1st","code_information":[{"code":"2202561","type":"CDM"},{"code":"360","type":"RC"},{"code":"27650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair/graft Achilles Tendon 1st","code_information":[{"code":"2202563","type":"CDM"},{"code":"360","type":"RC"},{"code":"27652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Resect/excise Lesion Skull 1st","code_information":[{"code":"2202592","type":"CDM"},{"code":"360","type":"RC"},{"code":"61615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Revise/replace Knee Joint 1st","code_information":[{"code":"2202616","type":"CDM"},{"code":"360","type":"RC"},{"code":"27486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Removal Of Ovary/tube(s) 1st","code_information":[{"code":"2202642","type":"CDM"},{"code":"360","type":"RC"},{"code":"58720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Of Nasal Septum 1st","code_information":[{"code":"2202648","type":"CDM"},{"code":"360","type":"RC"},{"code":"30520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Bladder Defect 1st","code_information":[{"code":"2202670","type":"CDM"},{"code":"360","type":"RC"},{"code":"57288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Skin Splt Grft Trnk/arm/leg 1st","code_information":[{"code":"2202682","type":"CDM"},{"code":"360","type":"RC"},{"code":"15100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Partial Hysterectomy 1st","code_information":[{"code":"2202696","type":"CDM"},{"code":"360","type":"RC"},{"code":"58180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Excise Wrist Tendon Sheath 1st","code_information":[{"code":"2202730","type":"CDM"},{"code":"360","type":"RC"},{"code":"25118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Tendon Excision Palm/finger 1st","code_information":[{"code":"2202734","type":"CDM"},{"code":"360","type":"RC"},{"code":"26145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Talectomy Astragalectomy 1st","code_information":[{"code":"2202736","type":"CDM"},{"code":"360","type":"RC"},{"code":"28130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Repair Elbow Deb/attch Open 1st","code_information":[{"code":"2202761","type":"CDM"},{"code":"360","type":"RC"},{"code":"24359","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Total Hysterectomy 1st","code_information":[{"code":"2202810","type":"CDM"},{"code":"360","type":"RC"},{"code":"58150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Prostatectomy (Turp) 1st","code_information":[{"code":"2202840","type":"CDM"},{"code":"360","type":"RC"},{"code":"52601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Vaginal Hysterectomy 1st","code_information":[{"code":"2202953","type":"CDM"},{"code":"360","type":"RC"},{"code":"58260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Vag Hyst Complex 1st","code_information":[{"code":"2202957","type":"CDM"},{"code":"360","type":"RC"},{"code":"58290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Or Level 4 1st 15min","code_information":[{"code":"2202984","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202984","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17450,"maximum":17450,"gross_charge":21812,"discounted_cash":21812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17450}]}]},{"description":"Transluminal Balloon Angioplasty (Except","code_information":[{"code":"28000757","type":"CDM"},{"code":"360","type":"RC"},{"code":"37248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":17427,"gross_charge":21784,"discounted_cash":21784,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17427},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17427},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17427}]}]},{"description":"J&j 14 Hole Plate","code_information":[{"code":"2800241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17252,"maximum":17252,"gross_charge":21565,"discounted_cash":21565,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17252},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17252},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17252}]}]},{"description":"Delta Modular Centered Epiphyssi Ha Coat","code_information":[{"code":"2800156","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16973,"maximum":16973,"gross_charge":21216,"discounted_cash":21216,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16973},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16973},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16973}]}]},{"description":"Zimmer Scp Kit","code_information":[{"code":"2800737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16800,"maximum":16800,"gross_charge":21000,"discounted_cash":21000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16800}]}]},{"description":"Biopsy/removal Lymph Nodes","code_information":[{"code":"600005","type":"CDM"},{"code":"509","type":"RC"},{"code":"38525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":16797,"gross_charge":20996,"discounted_cash":20996,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16797},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16797},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16797}]}]},{"description":"Orthofix 6mm Ml M6 Disch","code_information":[{"code":"2800340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16000,"maximum":16000,"gross_charge":20000,"discounted_cash":20000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16000}]}]},{"description":"Orthofix Polycarbonate Titanium 6mm","code_information":[{"code":"2800342","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16000,"maximum":16000,"gross_charge":20000,"discounted_cash":20000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16000}]}]},{"description":"Peek Cage18mm","code_information":[{"code":"2800348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16000,"maximum":16000,"gross_charge":20000,"discounted_cash":20000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16000}]}]},{"description":"Zavation Kymphoplasty Kit","code_information":[{"code":"2800726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16000,"maximum":16000,"gross_charge":20000,"discounted_cash":20000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16000}]}]},{"description":"Cystouretero W/lithotripsy","code_information":[{"code":"2200700","type":"CDM"},{"code":"790","type":"RC"},{"code":"52353","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":15952,"gross_charge":19940,"discounted_cash":19940,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15952},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15952},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15952},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2200}]}]},{"description":"Rpr Aa Hrn Rcr 3-10 Rdc","code_information":[{"code":"2211545","type":"CDM"},{"code":"360","type":"RC"},{"code":"49615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":15822,"gross_charge":19778,"discounted_cash":19778,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15822}]}]},{"description":"Removal Of Peritoneal Foreign Body From","code_information":[{"code":"2222545","type":"CDM"},{"code":"360","type":"RC"},{"code":"49402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":15822,"gross_charge":19778,"discounted_cash":19778,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15822}]}]},{"description":"Angiography Ext Bil Rad Sup&int","code_information":[{"code":"5000008","type":"CDM"},{"code":"329","type":"RC"},{"code":"75716","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":15718,"maximum":15718,"gross_charge":19648,"discounted_cash":19648,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15718},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15718}]}]},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"CP17428476722276128","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":15144,"gross_charge":18930,"discounted_cash":18930,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15144}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"CP17428476722270564","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":15082,"gross_charge":18852,"discounted_cash":18852,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15082}]}]},{"description":"Exc Hip/pelvis Les Sc < 3 Cm","code_information":[{"code":"2201202","type":"CDM"},{"code":"360","type":"RC"},{"code":"27047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":15077,"gross_charge":18846,"discounted_cash":18846,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15077},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15077},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15077}]}]},{"description":"Neurectomy Foot","code_information":[{"code":"2201914","type":"CDM"},{"code":"360","type":"RC"},{"code":"28055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":15077,"gross_charge":18846,"discounted_cash":18846,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15077},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15077},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15077}]}]},{"description":"New Or Level 2 1st 30 Mins","code_information":[{"code":"12202986","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202986","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15077,"maximum":15077,"gross_charge":18846,"discounted_cash":18846,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15077},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15077},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15077}]}]},{"description":"Venography Caval Infer W/serialography","code_information":[{"code":"5000200","type":"CDM"},{"code":"320","type":"RC"},{"code":"75825","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":15016,"maximum":15016,"gross_charge":18770,"discounted_cash":18770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15016}]}]},{"description":"Bard Phasix St 20x25m Mesh","code_information":[{"code":"2800124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15000,"maximum":15000,"gross_charge":18750,"discounted_cash":18750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15000}]}]},{"description":"Colonoscopy Flexible W/band Ligations","code_information":[{"code":"2200553","type":"CDM"},{"code":"750","type":"RC"},{"code":"45398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14851,"gross_charge":18564,"discounted_cash":18564,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14851},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14851},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14851}]}]},{"description":"Angio Pelvic Slct/supraslct Rad Sup&int","code_information":[{"code":"5000011","type":"CDM"},{"code":"329","type":"RC"},{"code":"75736","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14741,"maximum":14741,"gross_charge":18426,"discounted_cash":18426,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14741},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14741},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14741}]}]},{"description":"Excision Of Infected Graft; Extremity","code_information":[{"code":"2210559","type":"CDM"},{"code":"360","type":"RC"},{"code":"35903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14578,"maximum":14578,"gross_charge":18222,"discounted_cash":18222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14578}]}]},{"description":"Replacement, Complete, Of A Tunneled Cen","code_information":[{"code":"2212645","type":"CDM"},{"code":"360","type":"RC"},{"code":"36582","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14578,"gross_charge":18222,"discounted_cash":18222,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14578}]}]},{"description":"Endovenous Rf 1st Vein","code_information":[{"code":"2200887","type":"CDM"},{"code":"360","type":"RC"},{"code":"36475","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14512,"gross_charge":18140,"discounted_cash":18140,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14512},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14512},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14512}]}]},{"description":"Graft, Transmural Transvenous Arterial B","code_information":[{"code":"2222678","type":"CDM"},{"code":"279","type":"RC"},{"code":"C1604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14400,"maximum":14400,"gross_charge":18000,"discounted_cash":18000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14400}]}]},{"description":"Biopsy Breast Placement Clip","code_information":[{"code":"5100076","type":"CDM"},{"code":"761","type":"RC"},{"code":"19083","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14396,"maximum":14396,"gross_charge":17995,"discounted_cash":17995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14396},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14396},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14396}]}]},{"description":"Acromioplasty/acromionectomy Prtl 1st 15","code_information":[{"code":"2200004","type":"CDM"},{"code":"360","type":"RC"},{"code":"23130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Adenoidectomy Primary =>Age 12 1st 15 M","code_information":[{"code":"2200006","type":"CDM"},{"code":"360","type":"RC"},{"code":"42831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Adenoidectomy Primary <Age 12 1st 15 Min","code_information":[{"code":"2200008","type":"CDM"},{"code":"360","type":"RC"},{"code":"42830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Adenoidectomy Secondary =>Age 12 1st 15","code_information":[{"code":"2200010","type":"CDM"},{"code":"360","type":"RC"},{"code":"42836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Amputation Penis Partial 1st 15 Min","code_information":[{"code":"2200036","type":"CDM"},{"code":"360","type":"RC"},{"code":"54120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Amputation Of Finger/thumb 1st","code_information":[{"code":"2200038","type":"CDM"},{"code":"360","type":"RC"},{"code":"26951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Amputation Foot Midtarsal 1st 15 Min","code_information":[{"code":"2200042","type":"CDM"},{"code":"360","type":"RC"},{"code":"28800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Amputation Leg Through Tibia & Fibula 1","code_information":[{"code":"2200046","type":"CDM"},{"code":"360","type":"RC"},{"code":"27880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Amp Leg Through Tibia&fibula Re-amp 1st","code_information":[{"code":"2200048","type":"CDM"},{"code":"360","type":"RC"},{"code":"27886","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Amputation Metatarsal W/ Toe Single 1st","code_information":[{"code":"2200050","type":"CDM"},{"code":"360","type":"RC"},{"code":"28810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Amputation Toe Interphalangeal Joint 1st","code_information":[{"code":"2200052","type":"CDM"},{"code":"360","type":"RC"},{"code":"28825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Amputation Toe Mtp Joint 1st 15 Min","code_information":[{"code":"2200054","type":"CDM"},{"code":"360","type":"RC"},{"code":"28820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Anterior Colporrhaphy 1st","code_information":[{"code":"2200060","type":"CDM"},{"code":"360","type":"RC"},{"code":"57240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ant Vesicoure/urethropexy Cmp 1st 15 Min","code_information":[{"code":"2200068","type":"CDM"},{"code":"360","type":"RC"},{"code":"51841","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Appendectomy 1st 15 Min","code_information":[{"code":"2200072","type":"CDM"},{"code":"360","type":"RC"},{"code":"44950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Appendectomy 1st 15 Min","code_information":[{"code":"2200076","type":"CDM"},{"code":"360","type":"RC"},{"code":"44955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthrodesis Great Toe Ipj 1st 15 Min","code_information":[{"code":"2200136","type":"CDM"},{"code":"360","type":"RC"},{"code":"28755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthrodesis Great Toe Mtp Joint 1st 30 M","code_information":[{"code":"2200138","type":"CDM"},{"code":"360","type":"RC"},{"code":"28750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthrodesis Ipj W/wo Int Fixation 1st 30","code_information":[{"code":"2200140","type":"CDM"},{"code":"360","type":"RC"},{"code":"26860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthrodesis Interphal Joint W/wo Int Fix","code_information":[{"code":"2200142","type":"CDM"},{"code":"360","type":"RC"},{"code":"26861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Fusion Of Foot Bones 1st","code_information":[{"code":"2200150","type":"CDM"},{"code":"360","type":"RC"},{"code":"28735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Fusion Of Foot Bones 1st","code_information":[{"code":"2200152","type":"CDM"},{"code":"360","type":"RC"},{"code":"28740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Fusion Of Big Toe Joint 1st","code_information":[{"code":"2200171","type":"CDM"},{"code":"360","type":"RC"},{"code":"28760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Foot Bones 1st","code_information":[{"code":"2200173","type":"CDM"},{"code":"360","type":"RC"},{"code":"28737","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthrodesis Subtalar 1st","code_information":[{"code":"2200175","type":"CDM"},{"code":"360","type":"RC"},{"code":"28725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthro W/prosth Replace Trapezium 1st 15","code_information":[{"code":"2200179","type":"CDM"},{"code":"360","type":"RC"},{"code":"25445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ankle Arthroscopy/surgery 1st","code_information":[{"code":"2200206","type":"CDM"},{"code":"360","type":"RC"},{"code":"29892","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200210","type":"CDM"},{"code":"360","type":"RC"},{"code":"29850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Tibial Arthroscopy/surgery 1st","code_information":[{"code":"2200212","type":"CDM"},{"code":"360","type":"RC"},{"code":"29855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ankle Arthroscopy/surgery 1st","code_information":[{"code":"2200214","type":"CDM"},{"code":"360","type":"RC"},{"code":"29898","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ankle Arthroscopy/surgery 1st","code_information":[{"code":"2200218","type":"CDM"},{"code":"360","type":"RC"},{"code":"29895","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Elbow Arthroscopy 1st","code_information":[{"code":"2200224","type":"CDM"},{"code":"360","type":"RC"},{"code":"29830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthroscopy Elbow Debride Extens 1st 30","code_information":[{"code":"2200226","type":"CDM"},{"code":"360","type":"RC"},{"code":"29838","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy Dx 1st","code_information":[{"code":"2200230","type":"CDM"},{"code":"360","type":"RC"},{"code":"29870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200232","type":"CDM"},{"code":"360","type":"RC"},{"code":"29879","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200234","type":"CDM"},{"code":"360","type":"RC"},{"code":"29877","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200236","type":"CDM"},{"code":"360","type":"RC"},{"code":"29885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthroscopy Knee Infect/lav/drain 1st 15","code_information":[{"code":"2200238","type":"CDM"},{"code":"360","type":"RC"},{"code":"29871","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200240","type":"CDM"},{"code":"360","type":"RC"},{"code":"29874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200242","type":"CDM"},{"code":"360","type":"RC"},{"code":"29875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthro Knee Surg W/lat Release  1st","code_information":[{"code":"2200246","type":"CDM"},{"code":"360","type":"RC"},{"code":"29873","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200248","type":"CDM"},{"code":"360","type":"RC"},{"code":"29884","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200250","type":"CDM"},{"code":"360","type":"RC"},{"code":"29880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal of one knee cartilage using an endoscope","code_information":[{"code":"2200252","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthroscopy Knee W/meniscs Rep Med/lat 1","code_information":[{"code":"2200254","type":"CDM"},{"code":"360","type":"RC"},{"code":"29882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthroscopy Shoulder Debrid Exten 1st","code_information":[{"code":"2200262","type":"CDM"},{"code":"360","type":"RC"},{"code":"29823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthroscopy Shoulder Debride Lmtd 1st","code_information":[{"code":"2200264","type":"CDM"},{"code":"360","type":"RC"},{"code":"29822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthroscopy Shoulder Synovectomy Cmp 1st","code_information":[{"code":"2200272","type":"CDM"},{"code":"360","type":"RC"},{"code":"29821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Shoulder Arthroscopy/surgery 1st","code_information":[{"code":"2200274","type":"CDM"},{"code":"360","type":"RC"},{"code":"29825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthroscopy Shoulder W/removal Lb/fb 1st","code_information":[{"code":"2200276","type":"CDM"},{"code":"360","type":"RC"},{"code":"29819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthroscopy Subtalar Joint W/debride 1st","code_information":[{"code":"2200280","type":"CDM"},{"code":"360","type":"RC"},{"code":"29906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Wrist Arthroscopy 1st","code_information":[{"code":"2200282","type":"CDM"},{"code":"360","type":"RC"},{"code":"29840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Wrist Arthroscopy/surgery 1st","code_information":[{"code":"2200284","type":"CDM"},{"code":"360","type":"RC"},{"code":"29846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Explore/treat Ankle Joint 1st","code_information":[{"code":"2200294","type":"CDM"},{"code":"360","type":"RC"},{"code":"27620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exploration Of Knee Joint 1st","code_information":[{"code":"2200304","type":"CDM"},{"code":"360","type":"RC"},{"code":"27310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Explore/treat Knee Joint 1st","code_information":[{"code":"2200306","type":"CDM"},{"code":"360","type":"RC"},{"code":"27331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Arthrotomy With Synovectomy Ankle 1st","code_information":[{"code":"2200314","type":"CDM"},{"code":"360","type":"RC"},{"code":"27625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Augmentation Lower Jaw Bone 1st","code_information":[{"code":"2200326","type":"CDM"},{"code":"360","type":"RC"},{"code":"21125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Balloon Dilation Biliary Ducts  1st","code_information":[{"code":"2200338","type":"CDM"},{"code":"360","type":"RC"},{"code":"47542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Needle Biopsy Lymph Nodes By Needle 1st","code_information":[{"code":"2200365","type":"CDM"},{"code":"360","type":"RC"},{"code":"38505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Shoulder Capsule 1st","code_information":[{"code":"2200436","type":"CDM"},{"code":"360","type":"RC"},{"code":"23462","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Shoulder Capsule 1st","code_information":[{"code":"2200438","type":"CDM"},{"code":"360","type":"RC"},{"code":"23450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Capsulorrhaphy Anterior W/labral Rep 1st","code_information":[{"code":"2200440","type":"CDM"},{"code":"360","type":"RC"},{"code":"23455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Capsulotomy Ipj Ea Joint Sep Proc 1st 30","code_information":[{"code":"2200442","type":"CDM"},{"code":"360","type":"RC"},{"code":"28272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Release Of Foot Contracture 1st","code_information":[{"code":"2200444","type":"CDM"},{"code":"360","type":"RC"},{"code":"28270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Carpectomy All Bones Proximal Row 1st","code_information":[{"code":"2200446","type":"CDM"},{"code":"360","type":"RC"},{"code":"25215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cartilage Graft Nasal Septum 1st","code_information":[{"code":"2200450","type":"CDM"},{"code":"360","type":"RC"},{"code":"20912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Debridement Bone Incl Epidermis Dermis 1","code_information":[{"code":"2200452","type":"CDM"},{"code":"360","type":"RC"},{"code":"58340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ablate Inf Turbinate Superf 1st","code_information":[{"code":"2200454","type":"CDM"},{"code":"360","type":"RC"},{"code":"30801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cervical Lymphadenectomy Complete 1st","code_information":[{"code":"2200464","type":"CDM"},{"code":"360","type":"RC"},{"code":"38720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cholecystectomy With Cholangiography 1st","code_information":[{"code":"2200474","type":"CDM"},{"code":"360","type":"RC"},{"code":"47605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Chromotubation Oviduct Inc Mat 1st","code_information":[{"code":"2200476","type":"CDM"},{"code":"360","type":"RC"},{"code":"58350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Claviculectomy Partial 1st","code_information":[{"code":"2200483","type":"CDM"},{"code":"360","type":"RC"},{"code":"23120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Hip Socket Fracture 1st","code_information":[{"code":"2200485","type":"CDM"},{"code":"360","type":"RC"},{"code":"27222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Finger Fracture Each 1st","code_information":[{"code":"2200496","type":"CDM"},{"code":"360","type":"RC"},{"code":"26755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Fracture Radius/ulna 1st","code_information":[{"code":"2200501","type":"CDM"},{"code":"360","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Closed Tx Nasal Bone Fract W/stabil 1st","code_information":[{"code":"2200513","type":"CDM"},{"code":"360","type":"RC"},{"code":"21320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Closed Tx Septal&nose Fx 1st","code_information":[{"code":"2200517","type":"CDM"},{"code":"360","type":"RC"},{"code":"21337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Fracture Of Radius 1st","code_information":[{"code":"2200525","type":"CDM"},{"code":"360","type":"RC"},{"code":"25520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Closure Enterostomy Lg/sm Intest 1st 32","code_information":[{"code":"2200539","type":"CDM"},{"code":"360","type":"RC"},{"code":"44620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Closure Esophag/fistula Cervicl Appr 1st","code_information":[{"code":"2200541","type":"CDM"},{"code":"360","type":"RC"},{"code":"43420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Colon 1st","code_information":[{"code":"2200543","type":"CDM"},{"code":"360","type":"RC"},{"code":"44160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Colectomy Partial With Anastomosis 1st","code_information":[{"code":"2200545","type":"CDM"},{"code":"360","type":"RC"},{"code":"44140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Colon 1st","code_information":[{"code":"2200547","type":"CDM"},{"code":"360","type":"RC"},{"code":"44146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Colon 1st","code_information":[{"code":"2200549","type":"CDM"},{"code":"360","type":"RC"},{"code":"44143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Colpopexy Extraperitoneal 1st","code_information":[{"code":"2200569","type":"CDM"},{"code":"360","type":"RC"},{"code":"57282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Conz Of Cervix W/scope Leep 1st","code_information":[{"code":"2200573","type":"CDM"},{"code":"360","type":"RC"},{"code":"57461","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Colposcopy Vagina W/cervix 1st","code_information":[{"code":"2200575","type":"CDM"},{"code":"360","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Combined Anteroposterior Colporrhaphy 1s","code_information":[{"code":"2200579","type":"CDM"},{"code":"360","type":"RC"},{"code":"57260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cmbn Ap Colprhy W/ntrcl Rpr 1st","code_information":[{"code":"2200581","type":"CDM"},{"code":"360","type":"RC"},{"code":"57265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Conization Of Cervix 1st","code_information":[{"code":"2200585","type":"CDM"},{"code":"360","type":"RC"},{"code":"57520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Conization Of Cervix 1st","code_information":[{"code":"2200587","type":"CDM"},{"code":"360","type":"RC"},{"code":"57522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Control Throat Bleeding 1st","code_information":[{"code":"2200600","type":"CDM"},{"code":"360","type":"RC"},{"code":"42962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Coracoacromial Lgmnt Rel W/wo Acromio 1","code_information":[{"code":"2200604","type":"CDM"},{"code":"360","type":"RC"},{"code":"23415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Penis 1st","code_information":[{"code":"2200606","type":"CDM"},{"code":"360","type":"RC"},{"code":"54430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Correction Hallux Valgus 1st","code_information":[{"code":"2200613","type":"CDM"},{"code":"360","type":"RC"},{"code":"28298","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystotomy For Excision Bladder Tumor 1st","code_information":[{"code":"2200625","type":"CDM"},{"code":"360","type":"RC"},{"code":"51530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy Stone Removal 1st","code_information":[{"code":"2200627","type":"CDM"},{"code":"360","type":"RC"},{"code":"52325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200629","type":"CDM"},{"code":"360","type":"RC"},{"code":"52330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy Inject Material 1st","code_information":[{"code":"2200633","type":"CDM"},{"code":"360","type":"RC"},{"code":"52327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystourethroscopy Separate Procedure 1st","code_information":[{"code":"2200635","type":"CDM"},{"code":"360","type":"RC"},{"code":"52000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200637","type":"CDM"},{"code":"360","type":"RC"},{"code":"52285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystourethro W/drct Vision Int Urethro 1","code_information":[{"code":"2200639","type":"CDM"},{"code":"360","type":"RC"},{"code":"52276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystouretero W/congen Repr 1st","code_information":[{"code":"2200641","type":"CDM"},{"code":"360","type":"RC"},{"code":"52400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy Chemodenervation 1st","code_information":[{"code":"2200643","type":"CDM"},{"code":"360","type":"RC"},{"code":"52287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Radiotracer 1st","code_information":[{"code":"2200645","type":"CDM"},{"code":"360","type":"RC"},{"code":"52250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Create Passage To Kidney 1st","code_information":[{"code":"2200647","type":"CDM"},{"code":"360","type":"RC"},{"code":"52334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy Removal Of Clots 1st","code_information":[{"code":"2200649","type":"CDM"},{"code":"360","type":"RC"},{"code":"52001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystourethro Cut Ejacul Duct 1st","code_information":[{"code":"2200651","type":"CDM"},{"code":"360","type":"RC"},{"code":"52402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystouretero W/renal Strict 1st","code_information":[{"code":"2200653","type":"CDM"},{"code":"360","type":"RC"},{"code":"52346","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cysto/uretero Stricture Tx 1st","code_information":[{"code":"2200655","type":"CDM"},{"code":"360","type":"RC"},{"code":"52344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cysto/uretero W/up Stricture 1st","code_information":[{"code":"2200657","type":"CDM"},{"code":"360","type":"RC"},{"code":"52345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystourethroscopy With Biopsys 1st","code_information":[{"code":"2200659","type":"CDM"},{"code":"360","type":"RC"},{"code":"52204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200661","type":"CDM"},{"code":"360","type":"RC"},{"code":"52281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200663","type":"CDM"},{"code":"360","type":"RC"},{"code":"52260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200665","type":"CDM"},{"code":"360","type":"RC"},{"code":"52265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy & Duct Catheter 1st","code_information":[{"code":"2200667","type":"CDM"},{"code":"360","type":"RC"},{"code":"52010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200669","type":"CDM"},{"code":"360","type":"RC"},{"code":"52240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200671","type":"CDM"},{"code":"360","type":"RC"},{"code":"52235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200673","type":"CDM"},{"code":"360","type":"RC"},{"code":"52234","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200675","type":"CDM"},{"code":"360","type":"RC"},{"code":"52214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200677","type":"CDM"},{"code":"360","type":"RC"},{"code":"52224","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystourethro W/int Urethro Male 1st","code_information":[{"code":"2200683","type":"CDM"},{"code":"360","type":"RC"},{"code":"52275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200685","type":"CDM"},{"code":"360","type":"RC"},{"code":"52315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200687","type":"CDM"},{"code":"360","type":"RC"},{"code":"52310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200689","type":"CDM"},{"code":"360","type":"RC"},{"code":"52277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cysto W/steroid Inj Into Strict 1st","code_information":[{"code":"2200691","type":"CDM"},{"code":"360","type":"RC"},{"code":"52283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy & Ureter Catheter 1st","code_information":[{"code":"2200693","type":"CDM"},{"code":"360","type":"RC"},{"code":"52005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Biopsy 1st","code_information":[{"code":"2200695","type":"CDM"},{"code":"360","type":"RC"},{"code":"52007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystouretero & Or Pyeloscope 1st","code_information":[{"code":"2200697","type":"CDM"},{"code":"360","type":"RC"},{"code":"52351","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystouretero W/biopsy 1st","code_information":[{"code":"2200699","type":"CDM"},{"code":"360","type":"RC"},{"code":"52354","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystouretero W/stone Remove 1st","code_information":[{"code":"2200702","type":"CDM"},{"code":"360","type":"RC"},{"code":"52352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystouretero W/excise Tumor 1st","code_information":[{"code":"2200704","type":"CDM"},{"code":"360","type":"RC"},{"code":"52355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200706","type":"CDM"},{"code":"360","type":"RC"},{"code":"52305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200708","type":"CDM"},{"code":"360","type":"RC"},{"code":"52301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200710","type":"CDM"},{"code":"360","type":"RC"},{"code":"52300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cysto W/renal Stricture Tx 1st","code_information":[{"code":"2200712","type":"CDM"},{"code":"360","type":"RC"},{"code":"52343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cysto W/ureter Stricture Tx 1st","code_information":[{"code":"2200714","type":"CDM"},{"code":"360","type":"RC"},{"code":"52341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cysto W/up Stricture Tx 1st","code_information":[{"code":"2200716","type":"CDM"},{"code":"360","type":"RC"},{"code":"52342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Cystoscopy And Treatment 1st","code_information":[{"code":"2200718","type":"CDM"},{"code":"278","type":"RC"},{"code":"52290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Debridement Muscle &/Or Fascia  1st","code_information":[{"code":"2200727","type":"CDM"},{"code":"360","type":"RC"},{"code":"11046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Debride Abdom Wall 1st","code_information":[{"code":"2200733","type":"CDM"},{"code":"360","type":"RC"},{"code":"11005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Clean Out Mastoid Cavity 1st","code_information":[{"code":"2200741","type":"CDM"},{"code":"360","type":"RC"},{"code":"69222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Clean Out Mastoid Cavity 1st","code_information":[{"code":"2200743","type":"CDM"},{"code":"360","type":"RC"},{"code":"69220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Debride Skin Subq Tissue & Muscle 1st","code_information":[{"code":"2200749","type":"CDM"},{"code":"360","type":"RC"},{"code":"11043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Decompression Of Forearm 1st","code_information":[{"code":"2200757","type":"CDM"},{"code":"360","type":"RC"},{"code":"24495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Decompression Of Lower Leg 1st","code_information":[{"code":"2200759","type":"CDM"},{"code":"360","type":"RC"},{"code":"27600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Decompression Of Leg 1st","code_information":[{"code":"2200761","type":"CDM"},{"code":"360","type":"RC"},{"code":"27894","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Decompression Fasciotomy W/debridement 1","code_information":[{"code":"2200763","type":"CDM"},{"code":"360","type":"RC"},{"code":"27694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Decompression Plantar Digital Nerve 1st","code_information":[{"code":"2200765","type":"CDM"},{"code":"360","type":"RC"},{"code":"64726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Delayed Breast Prosthesis 1st","code_information":[{"code":"2200771","type":"CDM"},{"code":"360","type":"RC"},{"code":"19342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Dilate Esophagus 1/mult Pass 1st","code_information":[{"code":"2200812","type":"CDM"},{"code":"360","type":"RC"},{"code":"43450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Dilate Urethra Stricture 1st","code_information":[{"code":"2200814","type":"CDM"},{"code":"360","type":"RC"},{"code":"53620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Dilate Urethra Stricture 1st","code_information":[{"code":"2200816","type":"CDM"},{"code":"360","type":"RC"},{"code":"53600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Dilate Urethra Stricture 1st","code_information":[{"code":"2200818","type":"CDM"},{"code":"360","type":"RC"},{"code":"53605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Disarticulation At Knee 1st","code_information":[{"code":"2200820","type":"CDM"},{"code":"360","type":"RC"},{"code":"27598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Dissection Deep Jugular Nodes 1st","code_information":[{"code":"2200822","type":"CDM"},{"code":"360","type":"RC"},{"code":"38542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Esophagus Pouch 1st","code_information":[{"code":"2200824","type":"CDM"},{"code":"360","type":"RC"},{"code":"43130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Foot Fascia 1st","code_information":[{"code":"2200826","type":"CDM"},{"code":"360","type":"RC"},{"code":"28250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Drain Ext Ear Abscess/hematoma Smpl 1st","code_information":[{"code":"2200834","type":"CDM"},{"code":"360","type":"RC"},{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Drainage Retroperitoneal Abscess Open 1s","code_information":[{"code":"2200844","type":"CDM"},{"code":"360","type":"RC"},{"code":"49060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Dress/debrid P-thick Burn L 1st","code_information":[{"code":"2200850","type":"CDM"},{"code":"360","type":"RC"},{"code":"16030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Dress/debrid P-thick Burn M 1st","code_information":[{"code":"2200852","type":"CDM"},{"code":"360","type":"RC"},{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Endoscopic Injection/implant 1st","code_information":[{"code":"2200870","type":"CDM"},{"code":"360","type":"RC"},{"code":"51715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Endoscopic Plantar Fasciotomy 1st","code_information":[{"code":"2200872","type":"CDM"},{"code":"360","type":"RC"},{"code":"29893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ercp Remove Forgn Body Duct 1st","code_information":[{"code":"2200876","type":"CDM"},{"code":"360","type":"RC"},{"code":"43275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Endo Cholangiopancreatograph 1st","code_information":[{"code":"2200878","type":"CDM"},{"code":"360","type":"RC"},{"code":"43262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ercp Ea Duct/ampulla Dilate 1st","code_information":[{"code":"2200880","type":"CDM"},{"code":"360","type":"RC"},{"code":"43277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Wrist Endoscopy/surgery 1st","code_information":[{"code":"2200884","type":"CDM"},{"code":"360","type":"RC"},{"code":"29848","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Small Intestine 1st","code_information":[{"code":"2200890","type":"CDM"},{"code":"360","type":"RC"},{"code":"44120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Freeing Of Bowel Adhesion 1st","code_information":[{"code":"2200892","type":"CDM"},{"code":"360","type":"RC"},{"code":"44005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Egd Esophagogastrc Fndoplsty 1st","code_information":[{"code":"2200915","type":"CDM"},{"code":"360","type":"RC"},{"code":"43210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exchange Intraocular Lens 1st","code_information":[{"code":"2200928","type":"CDM"},{"code":"360","type":"RC"},{"code":"66986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Ulna 1st","code_information":[{"code":"2200934","type":"CDM"},{"code":"360","type":"RC"},{"code":"25240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Reremove Wrist Tendon Lesion 1st","code_information":[{"code":"2200954","type":"CDM"},{"code":"360","type":"RC"},{"code":"25112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excise Parotid Gland/lesion 1st","code_information":[{"code":"2200998","type":"CDM"},{"code":"360","type":"RC"},{"code":"42415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excise Parotid Gland/lesion 1st","code_information":[{"code":"2201000","type":"CDM"},{"code":"360","type":"RC"},{"code":"42410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excise Parotid Gland/lesion 1st","code_information":[{"code":"2201002","type":"CDM"},{"code":"360","type":"RC"},{"code":"42420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Femur Lesion 1st","code_information":[{"code":"2201040","type":"CDM"},{"code":"360","type":"RC"},{"code":"27355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Toe Lesions 1st","code_information":[{"code":"2201046","type":"CDM"},{"code":"360","type":"RC"},{"code":"28108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Ankle/heel Lesion 1st","code_information":[{"code":"2201048","type":"CDM"},{"code":"360","type":"RC"},{"code":"28100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Foot Lesion 1st","code_information":[{"code":"2201052","type":"CDM"},{"code":"360","type":"RC"},{"code":"28104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Lower Leg Bone Lesion 1st","code_information":[{"code":"2201056","type":"CDM"},{"code":"360","type":"RC"},{"code":"27635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excision Of Lingual Tonsil 1st","code_information":[{"code":"2201060","type":"CDM"},{"code":"360","type":"RC"},{"code":"42870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treatment Of Urethra Lesion 1st","code_information":[{"code":"2201066","type":"CDM"},{"code":"360","type":"RC"},{"code":"53265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exc Abdl Tum Deep 5 Cm/> 1st","code_information":[{"code":"2201078","type":"CDM"},{"code":"360","type":"RC"},{"code":"22901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exc Neck Tum Deep 5 Cm/> 1st","code_information":[{"code":"2201088","type":"CDM"},{"code":"360","type":"RC"},{"code":"21554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exc Neck Tum Deep < 5 Cm 1st","code_information":[{"code":"2201100","type":"CDM"},{"code":"360","type":"RC"},{"code":"21556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exc Abdl Tum Deep < 5 Cm 1st","code_information":[{"code":"2201104","type":"CDM"},{"code":"360","type":"RC"},{"code":"22900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exc Skin Abd 1st","code_information":[{"code":"2201132","type":"CDM"},{"code":"360","type":"RC"},{"code":"15830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excise Excess Skin & Tissue 1st","code_information":[{"code":"2201138","type":"CDM"},{"code":"360","type":"RC"},{"code":"15839","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excise Excess Skin Fat Pad 1st","code_information":[{"code":"2201140","type":"CDM"},{"code":"360","type":"RC"},{"code":"15838","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excision Nasal Polyps Extensive 1st","code_information":[{"code":"2201171","type":"CDM"},{"code":"360","type":"RC"},{"code":"30115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excision Olecranon Bursa 1st","code_information":[{"code":"2201175","type":"CDM"},{"code":"360","type":"RC"},{"code":"24105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Sacrum Pressure Sore 1st","code_information":[{"code":"2201189","type":"CDM"},{"code":"360","type":"RC"},{"code":"15934","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exc Shoulder Les Sc 3 Cm/> 1st","code_information":[{"code":"2201224","type":"CDM"},{"code":"360","type":"RC"},{"code":"23071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Explore Wound Abdomen 1st","code_information":[{"code":"2201242","type":"CDM"},{"code":"360","type":"RC"},{"code":"20102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exploration Of Abdomen 1st","code_information":[{"code":"2201254","type":"CDM"},{"code":"360","type":"RC"},{"code":"49000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Release Palm Contracture 1st","code_information":[{"code":"2201260","type":"CDM"},{"code":"360","type":"RC"},{"code":"26121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Pedicle E/n/e/l/ntroral 1st","code_information":[{"code":"2201286","type":"CDM"},{"code":"360","type":"RC"},{"code":"15576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Gastroplasty W/o V-band 1st","code_information":[{"code":"2201307","type":"CDM"},{"code":"360","type":"RC"},{"code":"43843","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Calf Tendon 1st","code_information":[{"code":"2201309","type":"CDM"},{"code":"360","type":"RC"},{"code":"27687","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Corrj Halux Rigdus W/implt 1st","code_information":[{"code":"2201323","type":"CDM"},{"code":"360","type":"RC"},{"code":"28291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Corrj Halux Rigdus W/o Implt 1st","code_information":[{"code":"2201325","type":"CDM"},{"code":"360","type":"RC"},{"code":"28289","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Toe 1st","code_information":[{"code":"2201329","type":"CDM"},{"code":"360","type":"RC"},{"code":"28160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Hysteroscopy Sterilization 1st","code_information":[{"code":"2201352","type":"CDM"},{"code":"360","type":"RC"},{"code":"58565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Immediate Breast Prosthesis 1st","code_information":[{"code":"2201366","type":"CDM"},{"code":"360","type":"RC"},{"code":"19340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"I&d Abscess P-spine L/s/ls 1st","code_information":[{"code":"2201414","type":"CDM"},{"code":"360","type":"RC"},{"code":"22015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Induced Abortion By D&c 1st","code_information":[{"code":"2201434","type":"CDM"},{"code":"360","type":"RC"},{"code":"59840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Groin Lymph Nodes 1st","code_information":[{"code":"2201438","type":"CDM"},{"code":"360","type":"RC"},{"code":"38760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Inj Platelet Rich Plasma Any Site 1st","code_information":[{"code":"2201478","type":"CDM"},{"code":"360","type":"RC"},{"code":"0232T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Insert Uro/ves Nck Sphincter 1st","code_information":[{"code":"2201544","type":"CDM"},{"code":"360","type":"RC"},{"code":"53445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Insert Multi-comp Penis Pros 1st","code_information":[{"code":"2201554","type":"CDM"},{"code":"360","type":"RC"},{"code":"54405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Insert Temp Bladder Cath 1st","code_information":[{"code":"2201566","type":"CDM"},{"code":"360","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Insert Tunneled Cv Cath 1st","code_information":[{"code":"2201570","type":"CDM"},{"code":"360","type":"RC"},{"code":"36563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Insert Tunneled Cv Cath 1st","code_information":[{"code":"2201572","type":"CDM"},{"code":"360","type":"RC"},{"code":"36561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Intern Neurolysis W Operat Microscop 1st","code_information":[{"code":"2201583","type":"CDM"},{"code":"360","type":"RC"},{"code":"64727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Ectopic Pregnancy 1st","code_information":[{"code":"2201628","type":"CDM"},{"code":"360","type":"RC"},{"code":"59151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Myotomy Heller 1st","code_information":[{"code":"2201630","type":"CDM"},{"code":"360","type":"RC"},{"code":"43279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Paraesoph Her Rpr W/mesh 1st","code_information":[{"code":"2201632","type":"CDM"},{"code":"360","type":"RC"},{"code":"43282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Inc Hern Recur Comp 1st","code_information":[{"code":"2201634","type":"CDM"},{"code":"360","type":"RC"},{"code":"49657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Inc Hernia Repair Recur 1st","code_information":[{"code":"2201636","type":"CDM"},{"code":"360","type":"RC"},{"code":"49656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Enterolysis 1st","code_information":[{"code":"2201644","type":"CDM"},{"code":"360","type":"RC"},{"code":"44180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Fundoplasty 1st","code_information":[{"code":"2201646","type":"CDM"},{"code":"360","type":"RC"},{"code":"43280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Gastric Bypass/roux-en-y 1st","code_information":[{"code":"2201658","type":"CDM"},{"code":"360","type":"RC"},{"code":"43644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Takedown Splenic Flex 1st","code_information":[{"code":"2201660","type":"CDM"},{"code":"360","type":"RC"},{"code":"44213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopic Myomectomy 1st","code_information":[{"code":"2201662","type":"CDM"},{"code":"360","type":"RC"},{"code":"58545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Paraesophag Hern Repair 1st","code_information":[{"code":"2201664","type":"CDM"},{"code":"360","type":"RC"},{"code":"43281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Inc Hern Repair Comp 1st","code_information":[{"code":"2201666","type":"CDM"},{"code":"360","type":"RC"},{"code":"49655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Vent/abd Hernia Repair 1st","code_information":[{"code":"2201672","type":"CDM"},{"code":"360","type":"RC"},{"code":"49652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Splenectomy 1st","code_information":[{"code":"2201674","type":"CDM"},{"code":"360","type":"RC"},{"code":"38120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lsh Uterus 250 G Or Less 1st","code_information":[{"code":"2201676","type":"CDM"},{"code":"360","type":"RC"},{"code":"58541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lsh W/t/o Ut 250 G Or Less 1st","code_information":[{"code":"2201678","type":"CDM"},{"code":"360","type":"RC"},{"code":"58542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lsh Uterus Above 250 G 1st","code_information":[{"code":"2201680","type":"CDM"},{"code":"360","type":"RC"},{"code":"58543","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lsh W/t/o Uterus Above 250 G 1st","code_information":[{"code":"2201682","type":"CDM"},{"code":"360","type":"RC"},{"code":"58544","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Tlh W/t/o 250 G Or Less 1st","code_information":[{"code":"2201688","type":"CDM"},{"code":"360","type":"RC"},{"code":"58571","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparo-vag Hyst Incl T/o 1st","code_information":[{"code":"2201690","type":"CDM"},{"code":"360","type":"RC"},{"code":"58552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal of gallbladder using an endoscope","code_information":[{"code":"2201698","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"47562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparo Cholecystectomy/graph 1st","code_information":[{"code":"2201700","type":"CDM"},{"code":"360","type":"RC"},{"code":"47563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparo Cholecystectomy/explr 1st","code_information":[{"code":"2201702","type":"CDM"},{"code":"360","type":"RC"},{"code":"47564","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"L Colectomy/coloproctostomy 1st","code_information":[{"code":"2201706","type":"CDM"},{"code":"360","type":"RC"},{"code":"44207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lap Colectomy Part W/ileum 1st","code_information":[{"code":"2201708","type":"CDM"},{"code":"360","type":"RC"},{"code":"44205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Aspiration 1st","code_information":[{"code":"2201714","type":"CDM"},{"code":"360","type":"RC"},{"code":"49322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Biopsy 1st","code_information":[{"code":"2201716","type":"CDM"},{"code":"360","type":"RC"},{"code":"49321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Tubal Cautery 1st","code_information":[{"code":"2201718","type":"CDM"},{"code":"360","type":"RC"},{"code":"58670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Excise Lesions 1st","code_information":[{"code":"2201720","type":"CDM"},{"code":"360","type":"RC"},{"code":"58662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Lysis 1st","code_information":[{"code":"2201724","type":"CDM"},{"code":"360","type":"RC"},{"code":"58660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Tubal Block 1st","code_information":[{"code":"2201726","type":"CDM"},{"code":"360","type":"RC"},{"code":"58671","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Remove Adnexa 1st","code_information":[{"code":"2201728","type":"CDM"},{"code":"360","type":"RC"},{"code":"58661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laryngoscopy W/biopsy 1st","code_information":[{"code":"2201730","type":"CDM"},{"code":"360","type":"RC"},{"code":"31535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laryngoscopy W/bx & Op Scope 1st","code_information":[{"code":"2201732","type":"CDM"},{"code":"360","type":"RC"},{"code":"31536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laryngoscopy W/exc Of Tumor 1st","code_information":[{"code":"2201734","type":"CDM"},{"code":"360","type":"RC"},{"code":"31540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Larynscop W/tumr Exc + Scope 1st","code_information":[{"code":"2201736","type":"CDM"},{"code":"360","type":"RC"},{"code":"31541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Vc Lesion W/scope 1st","code_information":[{"code":"2201738","type":"CDM"},{"code":"360","type":"RC"},{"code":"31545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laryngoscopy Indirect With Biopsy 1st","code_information":[{"code":"2201746","type":"CDM"},{"code":"360","type":"RC"},{"code":"31510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lateral Retinacular Release Open 1st","code_information":[{"code":"2201753","type":"CDM"},{"code":"360","type":"RC"},{"code":"27425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Lower Leg Tendons 1st","code_information":[{"code":"2201775","type":"CDM"},{"code":"360","type":"RC"},{"code":"27686","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Lower Leg Tendon 1st","code_information":[{"code":"2201777","type":"CDM"},{"code":"360","type":"RC"},{"code":"27685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Liga Hemorrhoid Vas Bund Inc Us Guid 1st","code_information":[{"code":"2201785","type":"CDM"},{"code":"360","type":"RC"},{"code":"0249T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Bladder Stone Comp 1st","code_information":[{"code":"2201789","type":"CDM"},{"code":"360","type":"RC"},{"code":"52318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Lumbar Cervical 1st","code_information":[{"code":"2201794","type":"CDM"},{"code":"360","type":"RC"},{"code":"28715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Adhesiolysis Tube Ovary 1st","code_information":[{"code":"2201798","type":"CDM"},{"code":"360","type":"RC"},{"code":"58740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Enlarge Breast 1st","code_information":[{"code":"2201806","type":"CDM"},{"code":"360","type":"RC"},{"code":"19324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"P-mastectomy W/ln Removal 1st","code_information":[{"code":"2201825","type":"CDM"},{"code":"360","type":"RC"},{"code":"19302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Takedown Splenic Flexure W Colectomy 1st","code_information":[{"code":"2201842","type":"CDM"},{"code":"360","type":"RC"},{"code":"44139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Muscle-skin Graft Leg 1st","code_information":[{"code":"2201844","type":"CDM"},{"code":"360","type":"RC"},{"code":"15738","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Myomectomy Abdom Complex 1st","code_information":[{"code":"2201853","type":"CDM"},{"code":"360","type":"RC"},{"code":"58146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Eardrum 1st","code_information":[{"code":"2201855","type":"CDM"},{"code":"360","type":"RC"},{"code":"69620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nasal Endoscopy Dx 1st","code_information":[{"code":"2201860","type":"CDM"},{"code":"360","type":"RC"},{"code":"31231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc Dx Max Sinusc 1st","code_information":[{"code":"2201870","type":"CDM"},{"code":"360","type":"RC"},{"code":"31233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc Dx Sphn Sinusc 1st","code_information":[{"code":"2201872","type":"CDM"},{"code":"360","type":"RC"},{"code":"31235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc Frnt Tiss Rmvl 1st","code_information":[{"code":"2201874","type":"CDM"},{"code":"360","type":"RC"},{"code":"31276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Exploration Maxillary Sinus 1st","code_information":[{"code":"2201876","type":"CDM"},{"code":"360","type":"RC"},{"code":"31256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Endoscopy Maxillary Sinus 1st","code_information":[{"code":"2201878","type":"CDM"},{"code":"360","type":"RC"},{"code":"31267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nasal/sinus Endoscopy Surg 1st","code_information":[{"code":"2201880","type":"CDM"},{"code":"360","type":"RC"},{"code":"31290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nasal/sinus Endoscopy Surg 1st","code_information":[{"code":"2201882","type":"CDM"},{"code":"360","type":"RC"},{"code":"31291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nasal/sinus Endoscopy Surg 1st","code_information":[{"code":"2201884","type":"CDM"},{"code":"360","type":"RC"},{"code":"31287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nasal/sinus Endoscopy Surg 1st","code_information":[{"code":"2201886","type":"CDM"},{"code":"360","type":"RC"},{"code":"31288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nasal/sinus Endoscopy Surg 1st","code_information":[{"code":"2201888","type":"CDM"},{"code":"360","type":"RC"},{"code":"31237","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc Surg Max Sins 1st","code_information":[{"code":"2201895","type":"CDM"},{"code":"360","type":"RC"},{"code":"31295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc W/prtl Ethmdct 1st","code_information":[{"code":"2201899","type":"CDM"},{"code":"360","type":"RC"},{"code":"31254","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc W/tot Ethmdct 1st","code_information":[{"code":"2201901","type":"CDM"},{"code":"360","type":"RC"},{"code":"31255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc Med/inf Dcmprn 1st","code_information":[{"code":"2201903","type":"CDM"},{"code":"360","type":"RC"},{"code":"31292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc Med&inf Dcmprn 1st","code_information":[{"code":"2201905","type":"CDM"},{"code":"360","type":"RC"},{"code":"31293","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nsl/sins Ndsc Surg On Dcmprn 1st","code_information":[{"code":"2201907","type":"CDM"},{"code":"360","type":"RC"},{"code":"31294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Nerve Repair W/allograft 1st","code_information":[{"code":"2201913","type":"CDM"},{"code":"360","type":"RC"},{"code":"64910","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Cranial Nerve 1st","code_information":[{"code":"2201917","type":"CDM"},{"code":"360","type":"RC"},{"code":"64716","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Carpal Tunnel Surgery 1st","code_information":[{"code":"2201919","type":"CDM"},{"code":"360","type":"RC"},{"code":"64721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Ulnar Nerve At Elbow 1st","code_information":[{"code":"2201921","type":"CDM"},{"code":"360","type":"RC"},{"code":"64718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Ulnar Nerve At Wrist 1st","code_information":[{"code":"2201923","type":"CDM"},{"code":"360","type":"RC"},{"code":"64719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Arm Nerve(s) 1st","code_information":[{"code":"2201925","type":"CDM"},{"code":"360","type":"RC"},{"code":"64713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Low Back Nerve(s) 1st","code_information":[{"code":"2201927","type":"CDM"},{"code":"360","type":"RC"},{"code":"64714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Arm/leg Nerve 1st","code_information":[{"code":"2201929","type":"CDM"},{"code":"360","type":"RC"},{"code":"64708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Sciatic Nerve 1st","code_information":[{"code":"2201931","type":"CDM"},{"code":"360","type":"RC"},{"code":"64712","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Finger/toe Nerve 1st","code_information":[{"code":"2201933","type":"CDM"},{"code":"360","type":"RC"},{"code":"64702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Neuroplasty Nerve Hand Or Foot 1st","code_information":[{"code":"2201935","type":"CDM"},{"code":"360","type":"RC"},{"code":"64704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Omentum 1st","code_information":[{"code":"2201939","type":"CDM"},{"code":"360","type":"RC"},{"code":"49255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Clavicle Dislocation 1st","code_information":[{"code":"2201945","type":"CDM"},{"code":"360","type":"RC"},{"code":"23550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Clavicle Dislocation 1st","code_information":[{"code":"2201947","type":"CDM"},{"code":"360","type":"RC"},{"code":"23552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Finger Fracture Each 1st","code_information":[{"code":"2201951","type":"CDM"},{"code":"360","type":"RC"},{"code":"26746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Heel Fracture 1st","code_information":[{"code":"2201955","type":"CDM"},{"code":"360","type":"RC"},{"code":"28415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Clavicle Fracture 1st","code_information":[{"code":"2201959","type":"CDM"},{"code":"360","type":"RC"},{"code":"23515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Open Treatment Coccygeal Fracture 1st","code_information":[{"code":"2201961","type":"CDM"},{"code":"360","type":"RC"},{"code":"27202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Lower Jaw Fracture 1st","code_information":[{"code":"2201963","type":"CDM"},{"code":"360","type":"RC"},{"code":"21470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Finger Fracture Each 1st","code_information":[{"code":"2201967","type":"CDM"},{"code":"360","type":"RC"},{"code":"26765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Fx Rad Extra-articul 1st","code_information":[{"code":"2201969","type":"CDM"},{"code":"360","type":"RC"},{"code":"25607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Fx Rad Intra-articul 1st","code_information":[{"code":"2201971","type":"CDM"},{"code":"360","type":"RC"},{"code":"25608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Fx Radial 3+ Frag 1st","code_information":[{"code":"2201973","type":"CDM"},{"code":"360","type":"RC"},{"code":"25609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Lower Leg Joint 1st","code_information":[{"code":"2201975","type":"CDM"},{"code":"360","type":"RC"},{"code":"27829","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treatment Of Thigh Fracture 1st","code_information":[{"code":"2201977","type":"CDM"},{"code":"360","type":"RC"},{"code":"27514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Thigh Fracture 1st","code_information":[{"code":"2201979","type":"CDM"},{"code":"360","type":"RC"},{"code":"27236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treatment Of Thigh Fracture 1st","code_information":[{"code":"2201983","type":"CDM"},{"code":"360","type":"RC"},{"code":"27511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Lower Leg Fracture 1st","code_information":[{"code":"2201987","type":"CDM"},{"code":"360","type":"RC"},{"code":"27828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Lower Leg Fracture 1st","code_information":[{"code":"2201989","type":"CDM"},{"code":"360","type":"RC"},{"code":"27827","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Thigh Fracture 1st","code_information":[{"code":"2201997","type":"CDM"},{"code":"360","type":"RC"},{"code":"27248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Humerus Fracture 1st","code_information":[{"code":"2202001","type":"CDM"},{"code":"360","type":"RC"},{"code":"24575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Humerus Fracture 1st","code_information":[{"code":"2202005","type":"CDM"},{"code":"360","type":"RC"},{"code":"24546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Humerus Fracture 1st","code_information":[{"code":"2202007","type":"CDM"},{"code":"360","type":"RC"},{"code":"24545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Finger Dislocation 1st","code_information":[{"code":"2202011","type":"CDM"},{"code":"360","type":"RC"},{"code":"26785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Lower Jaw Fracture 1st","code_information":[{"code":"2202013","type":"CDM"},{"code":"360","type":"RC"},{"code":"21465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Opn Tx Orbit Periorbtl Implt 1st","code_information":[{"code":"2202023","type":"CDM"},{"code":"360","type":"RC"},{"code":"21390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Opn Tx Orbit Fx Transantral 1st","code_information":[{"code":"2202025","type":"CDM"},{"code":"360","type":"RC"},{"code":"21385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Kneecap Fracture 1st","code_information":[{"code":"2202027","type":"CDM"},{"code":"360","type":"RC"},{"code":"27524","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Radius Fracture 1st","code_information":[{"code":"2202039","type":"CDM"},{"code":"360","type":"RC"},{"code":"24665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Radius Fracture 1st","code_information":[{"code":"2202041","type":"CDM"},{"code":"360","type":"RC"},{"code":"24666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Fracture Of Radius 1st","code_information":[{"code":"2202045","type":"CDM"},{"code":"360","type":"RC"},{"code":"25525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Foot Dislocation 1st","code_information":[{"code":"2202049","type":"CDM"},{"code":"360","type":"RC"},{"code":"28585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Foot Dislocation 1st","code_information":[{"code":"2202053","type":"CDM"},{"code":"360","type":"RC"},{"code":"28615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Knee Fracture 1st","code_information":[{"code":"2202055","type":"CDM"},{"code":"360","type":"RC"},{"code":"27536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Knee Fracture 1st","code_information":[{"code":"2202057","type":"CDM"},{"code":"360","type":"RC"},{"code":"27535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Ulnar Fracture 1st","code_information":[{"code":"2202065","type":"CDM"},{"code":"360","type":"RC"},{"code":"24685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Fracture Of Ulna 1st","code_information":[{"code":"2202067","type":"CDM"},{"code":"360","type":"RC"},{"code":"25545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Open Treatment Ulnar Styloid Fracture 1s","code_information":[{"code":"2202069","type":"CDM"},{"code":"360","type":"RC"},{"code":"25652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Tendon Transfer With Graft 1st","code_information":[{"code":"2202073","type":"CDM"},{"code":"360","type":"RC"},{"code":"26492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ostectomy Calcaneus 1st","code_information":[{"code":"2202081","type":"CDM"},{"code":"360","type":"RC"},{"code":"28118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Heel Spur 1st","code_information":[{"code":"2202083","type":"CDM"},{"code":"360","type":"RC"},{"code":"28119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Part Removal Of Metatarsal 1st","code_information":[{"code":"2202085","type":"CDM"},{"code":"360","type":"RC"},{"code":"28113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Part Removal Of Metatarsal 1st","code_information":[{"code":"2202087","type":"CDM"},{"code":"360","type":"RC"},{"code":"28111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Part Removal Of Metatarsal 1st","code_information":[{"code":"2202089","type":"CDM"},{"code":"360","type":"RC"},{"code":"28112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Ostectomy Excision Tarsal Coalition 1st","code_information":[{"code":"2202091","type":"CDM"},{"code":"360","type":"RC"},{"code":"28116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Part Removal Of Metatarsal 1st","code_information":[{"code":"2202093","type":"CDM"},{"code":"360","type":"RC"},{"code":"28110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Foot Bone 1st","code_information":[{"code":"2202095","type":"CDM"},{"code":"360","type":"RC"},{"code":"28288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Collar Bone 1st","code_information":[{"code":"2202108","type":"CDM"},{"code":"360","type":"RC"},{"code":"23485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Big Toe 1st","code_information":[{"code":"2202112","type":"CDM"},{"code":"360","type":"RC"},{"code":"28310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Midfoot Bones 1st","code_information":[{"code":"2202114","type":"CDM"},{"code":"360","type":"RC"},{"code":"28304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incise/graft Midfoot Bones 1st","code_information":[{"code":"2202116","type":"CDM"},{"code":"360","type":"RC"},{"code":"28305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Osteotomy Fibula 1st","code_information":[{"code":"2202124","type":"CDM"},{"code":"360","type":"RC"},{"code":"27707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Osteotomy Phalanx Finger Each 1st","code_information":[{"code":"2202126","type":"CDM"},{"code":"360","type":"RC"},{"code":"26567","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Osteotomy Talus 1st","code_information":[{"code":"2202128","type":"CDM"},{"code":"360","type":"RC"},{"code":"28302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Ovarian Cyst(s) 1st","code_information":[{"code":"2202134","type":"CDM"},{"code":"360","type":"RC"},{"code":"58925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Palate Pharynx/uvula 1st","code_information":[{"code":"2202136","type":"CDM"},{"code":"360","type":"RC"},{"code":"42145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Excise Anal Ext Tag/papilla 1st","code_information":[{"code":"2202138","type":"CDM"},{"code":"360","type":"RC"},{"code":"46220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Esophagus 1st","code_information":[{"code":"2202140","type":"CDM"},{"code":"360","type":"RC"},{"code":"43122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Fibula 1st","code_information":[{"code":"2202142","type":"CDM"},{"code":"360","type":"RC"},{"code":"27641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Collar Bone Lesion 1st","code_information":[{"code":"2202146","type":"CDM"},{"code":"360","type":"RC"},{"code":"23180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Humerus Lesion 1st","code_information":[{"code":"2202148","type":"CDM"},{"code":"360","type":"RC"},{"code":"23184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Shoulder Blade Lesion 1st","code_information":[{"code":"2202150","type":"CDM"},{"code":"360","type":"RC"},{"code":"23182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Hand Bone 1st","code_information":[{"code":"2202154","type":"CDM"},{"code":"360","type":"RC"},{"code":"26230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Toe 1st","code_information":[{"code":"2202156","type":"CDM"},{"code":"360","type":"RC"},{"code":"28124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Part Removal Of Ankle/heel 1st","code_information":[{"code":"2202158","type":"CDM"},{"code":"360","type":"RC"},{"code":"28120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Foot Bone 1st","code_information":[{"code":"2202160","type":"CDM"},{"code":"360","type":"RC"},{"code":"28122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Thyroid Excision 1st","code_information":[{"code":"2202162","type":"CDM"},{"code":"360","type":"RC"},{"code":"60212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Thyroid Excision 1st","code_information":[{"code":"2202164","type":"CDM"},{"code":"360","type":"RC"},{"code":"60210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Patellectomy Or Hemipatellectomy 1st","code_information":[{"code":"2202166","type":"CDM"},{"code":"360","type":"RC"},{"code":"27350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Pin Hand Dislocation 1st","code_information":[{"code":"2202178","type":"CDM"},{"code":"360","type":"RC"},{"code":"26676","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Pin Finger Fracture Each 1st","code_information":[{"code":"2202180","type":"CDM"},{"code":"360","type":"RC"},{"code":"26756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Thigh Fracture 1st","code_information":[{"code":"2202186","type":"CDM"},{"code":"360","type":"RC"},{"code":"27235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Big Toe Fracture 1st","code_information":[{"code":"2202188","type":"CDM"},{"code":"360","type":"RC"},{"code":"28496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Metacarpal Fracture 1st","code_information":[{"code":"2202194","type":"CDM"},{"code":"360","type":"RC"},{"code":"26608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Metatarsal Fracture 1st","code_information":[{"code":"2202196","type":"CDM"},{"code":"360","type":"RC"},{"code":"28476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Humerus Fracture 1st","code_information":[{"code":"2202198","type":"CDM"},{"code":"360","type":"RC"},{"code":"24538","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Foot Dislocation 1st","code_information":[{"code":"2202200","type":"CDM"},{"code":"360","type":"RC"},{"code":"28606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Percutaneous Vertebroplasty 1st","code_information":[{"code":"2202218","type":"CDM"},{"code":"360","type":"RC"},{"code":"22522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Perineum 1st","code_information":[{"code":"2202220","type":"CDM"},{"code":"360","type":"RC"},{"code":"56810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Reconstruction Of Throat 1st","code_information":[{"code":"2202226","type":"CDM"},{"code":"360","type":"RC"},{"code":"42950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Pterygomaxillary Fossa Any Approach 1st","code_information":[{"code":"2202257","type":"CDM"},{"code":"360","type":"RC"},{"code":"31040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Wrist/forearm Lesion 1st","code_information":[{"code":"2202270","type":"CDM"},{"code":"360","type":"RC"},{"code":"25115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Foot Tendon 1st","code_information":[{"code":"2202299","type":"CDM"},{"code":"360","type":"RC"},{"code":"28238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Unstable Kneecap 1st","code_information":[{"code":"2202305","type":"CDM"},{"code":"360","type":"RC"},{"code":"27420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Unstable Kneecap 1st","code_information":[{"code":"2202307","type":"CDM"},{"code":"360","type":"RC"},{"code":"27422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Reduce Bowel Obstruction 1st","code_information":[{"code":"2202319","type":"CDM"},{"code":"360","type":"RC"},{"code":"44050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Stent Via Transureth 1st","code_information":[{"code":"2202329","type":"CDM"},{"code":"360","type":"RC"},{"code":"50386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove/replace Penis Prosth 1st","code_information":[{"code":"2202331","type":"CDM"},{"code":"360","type":"RC"},{"code":"54410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove/replace Ur Sphincter 1st","code_information":[{"code":"2202333","type":"CDM"},{"code":"360","type":"RC"},{"code":"53447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Clear Outer Ear Canal 1st","code_information":[{"code":"2202337","type":"CDM"},{"code":"360","type":"RC"},{"code":"69205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Muti-comp Penis Pros 1st","code_information":[{"code":"2202347","type":"CDM"},{"code":"360","type":"RC"},{"code":"54406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Foreign Body Foot Complicated 1s","code_information":[{"code":"2202358","type":"CDM"},{"code":"360","type":"RC"},{"code":"28193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Foreign Body Foot Deep 1st","code_information":[{"code":"2202360","type":"CDM"},{"code":"360","type":"RC"},{"code":"28192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Hip Prosthesis 1st","code_information":[{"code":"2202366","type":"CDM"},{"code":"360","type":"RC"},{"code":"27090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Support Implant 1st","code_information":[{"code":"2202372","type":"CDM"},{"code":"360","type":"RC"},{"code":"20670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Mammary Implant Material 1st","code_information":[{"code":"2202378","type":"CDM"},{"code":"360","type":"RC"},{"code":"19330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Eye Fluid 1st","code_information":[{"code":"2202411","type":"CDM"},{"code":"360","type":"RC"},{"code":"67005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Bone Fixation Device 1st","code_information":[{"code":"2202417","type":"CDM"},{"code":"360","type":"RC"},{"code":"20694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rpr Epigastric Hern Blocked 1st","code_information":[{"code":"2202423","type":"CDM"},{"code":"360","type":"RC"},{"code":"49572","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rpr Ventral Hern Init Block 1st","code_information":[{"code":"2202427","type":"CDM"},{"code":"360","type":"RC"},{"code":"49561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rpr Ventral Hern Init Reduc 1st","code_information":[{"code":"2202429","type":"CDM"},{"code":"360","type":"RC"},{"code":"49560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Prp I/hern Init Block >5 Yr 1st","code_information":[{"code":"2202431","type":"CDM"},{"code":"360","type":"RC"},{"code":"49507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair of groin hernia patient age 5 years or older","code_information":[{"code":"2202433","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"49505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Lumbar Hernia 1st","code_information":[{"code":"2202439","type":"CDM"},{"code":"360","type":"RC"},{"code":"49540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Nasal Septal Perforations 1st","code_information":[{"code":"2202443","type":"CDM"},{"code":"360","type":"RC"},{"code":"30630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Nasal Stenosis W/ Implant 1st","code_information":[{"code":"2202445","type":"CDM"},{"code":"360","type":"RC"},{"code":"C9749","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Tunneled Cv Cath 1st","code_information":[{"code":"2202453","type":"CDM"},{"code":"360","type":"RC"},{"code":"36576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Hand Joint 1st","code_information":[{"code":"2202455","type":"CDM"},{"code":"360","type":"RC"},{"code":"26540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Eyelid Defect 1st","code_information":[{"code":"2202461","type":"CDM"},{"code":"360","type":"RC"},{"code":"67917","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Finger/hand Tendon 1st","code_information":[{"code":"2202465","type":"CDM"},{"code":"360","type":"RC"},{"code":"26426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair/graft Finger Tendon 1st","code_information":[{"code":"2202467","type":"CDM"},{"code":"360","type":"RC"},{"code":"26428","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Finger Tendon 1st","code_information":[{"code":"2202469","type":"CDM"},{"code":"360","type":"RC"},{"code":"26433","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Spinal Herniation 1st","code_information":[{"code":"2202473","type":"CDM"},{"code":"360","type":"RC"},{"code":"63706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Radius Or Ulna 1st","code_information":[{"code":"2202479","type":"CDM"},{"code":"360","type":"RC"},{"code":"25400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Rotator Cuff Acute 1st","code_information":[{"code":"2202485","type":"CDM"},{"code":"360","type":"RC"},{"code":"23410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Hydrocele 1st","code_information":[{"code":"2202489","type":"CDM"},{"code":"360","type":"RC"},{"code":"55060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rerepair Fem Hernia Blocked 1st","code_information":[{"code":"2202501","type":"CDM"},{"code":"360","type":"RC"},{"code":"49557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rerepair Ventrl Hern Reduce 1st","code_information":[{"code":"2202505","type":"CDM"},{"code":"360","type":"RC"},{"code":"49565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rerepair Ing Hernia Blocked 1st","code_information":[{"code":"2202507","type":"CDM"},{"code":"360","type":"RC"},{"code":"49521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rerepair Ing Hernia Reduce 1st","code_information":[{"code":"2202509","type":"CDM"},{"code":"360","type":"RC"},{"code":"49520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rpr Umbil Hern Block > 5 Yr 1st","code_information":[{"code":"2202511","type":"CDM"},{"code":"360","type":"RC"},{"code":"49587","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Rpr Umbil Hern Reduc > 5 Yr 1st","code_information":[{"code":"2202513","type":"CDM"},{"code":"360","type":"RC"},{"code":"49585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Hand Tendon 1st","code_information":[{"code":"2202539","type":"CDM"},{"code":"360","type":"RC"},{"code":"26410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Leg Tendon Each 1st","code_information":[{"code":"2202541","type":"CDM"},{"code":"360","type":"RC"},{"code":"27658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Leg Tendon Each 1st","code_information":[{"code":"2202543","type":"CDM"},{"code":"360","type":"RC"},{"code":"27659","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Muscles Of Hand 1st","code_information":[{"code":"2202547","type":"CDM"},{"code":"360","type":"RC"},{"code":"26591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Thigh 1st","code_information":[{"code":"2202551","type":"CDM"},{"code":"360","type":"RC"},{"code":"27470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Metatarsals 1st","code_information":[{"code":"2202553","type":"CDM"},{"code":"360","type":"RC"},{"code":"28322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Nonunion Or Malunion Tarsal Bones","code_information":[{"code":"2202555","type":"CDM"},{"code":"360","type":"RC"},{"code":"28320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Ankle Ligaments 1st","code_information":[{"code":"2202557","type":"CDM"},{"code":"360","type":"RC"},{"code":"27696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Knee Ligament 1st","code_information":[{"code":"2202565","type":"CDM"},{"code":"360","type":"RC"},{"code":"27405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Achilles Tendon 1st","code_information":[{"code":"2202568","type":"CDM"},{"code":"360","type":"RC"},{"code":"27654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Ankle Ligament 1st","code_information":[{"code":"2202570","type":"CDM"},{"code":"360","type":"RC"},{"code":"27698","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Forearm Tendon/muscle 1st","code_information":[{"code":"2202572","type":"CDM"},{"code":"360","type":"RC"},{"code":"25270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Forearm Tendon/muscle 1st","code_information":[{"code":"2202574","type":"CDM"},{"code":"360","type":"RC"},{"code":"25260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Arm Tendon/muscle 1st","code_information":[{"code":"2202576","type":"CDM"},{"code":"360","type":"RC"},{"code":"24341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Foot Tendon 1st","code_information":[{"code":"2202578","type":"CDM"},{"code":"360","type":"RC"},{"code":"28208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Foot Tendon 1st","code_information":[{"code":"2202580","type":"CDM"},{"code":"360","type":"RC"},{"code":"28200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Foot Tendon 1st","code_information":[{"code":"2202582","type":"CDM"},{"code":"360","type":"RC"},{"code":"28202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Resect Ovarian Malignancy 1st","code_information":[{"code":"2202588","type":"CDM"},{"code":"360","type":"RC"},{"code":"58950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Resection Scrotum 1st","code_information":[{"code":"2202590","type":"CDM"},{"code":"360","type":"RC"},{"code":"55150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Toe 1st","code_information":[{"code":"2202594","type":"CDM"},{"code":"360","type":"RC"},{"code":"28126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Vag Graft Via Vagina 1st","code_information":[{"code":"2202596","type":"CDM"},{"code":"360","type":"RC"},{"code":"57295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Colostomy 1st","code_information":[{"code":"2202604","type":"CDM"},{"code":"360","type":"RC"},{"code":"44340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Hip Joint Replacement 1st","code_information":[{"code":"2202608","type":"CDM"},{"code":"360","type":"RC"},{"code":"27137","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Reconstruction Of Nose 1st","code_information":[{"code":"2202628","type":"CDM"},{"code":"360","type":"RC"},{"code":"30410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Reconstruction Of Nose 1st","code_information":[{"code":"2202630","type":"CDM"},{"code":"360","type":"RC"},{"code":"30420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Nose 1st","code_information":[{"code":"2202634","type":"CDM"},{"code":"360","type":"RC"},{"code":"30450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revision Of Nose 1st","code_information":[{"code":"2202636","type":"CDM"},{"code":"360","type":"RC"},{"code":"30430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Late Closure Of Wound 1st","code_information":[{"code":"2202646","type":"CDM"},{"code":"360","type":"RC"},{"code":"13160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Sesamoid Bone 1st","code_information":[{"code":"2202650","type":"CDM"},{"code":"360","type":"RC"},{"code":"28315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Skn Splt A-grft Fac/nck/hf/g 1st","code_information":[{"code":"2202678","type":"CDM"},{"code":"360","type":"RC"},{"code":"15120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Splitthickness Autograft Tr/a/l 1st","code_information":[{"code":"2202680","type":"CDM"},{"code":"360","type":"RC"},{"code":"15101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Resect Inferior Turbinate 1st","code_information":[{"code":"2202686","type":"CDM"},{"code":"360","type":"RC"},{"code":"30140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Suction Assisted Lipectomy Head&neck 1st","code_information":[{"code":"2202688","type":"CDM"},{"code":"360","type":"RC"},{"code":"15876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Suction Lipectomy Lwr Extrem 1st","code_information":[{"code":"2202690","type":"CDM"},{"code":"360","type":"RC"},{"code":"15879","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Suction Assisted Lipectomy Trunk 1st","code_information":[{"code":"2202692","type":"CDM"},{"code":"360","type":"RC"},{"code":"15877","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Suction Lipectomy Upr Extrem 1st","code_information":[{"code":"2202694","type":"CDM"},{"code":"360","type":"RC"},{"code":"15878","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Anal Fist Complex 1st","code_information":[{"code":"2202704","type":"CDM"},{"code":"360","type":"RC"},{"code":"46280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Anal Fist 2 Stage 1st","code_information":[{"code":"2202706","type":"CDM"},{"code":"360","type":"RC"},{"code":"46285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Anal Fist Subq 1st","code_information":[{"code":"2202708","type":"CDM"},{"code":"360","type":"RC"},{"code":"46270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Anal Fist Inter 1st","code_information":[{"code":"2202710","type":"CDM"},{"code":"360","type":"RC"},{"code":"46275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treat Ectopic Pregnancy 1st","code_information":[{"code":"2202712","type":"CDM"},{"code":"360","type":"RC"},{"code":"59120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Digit Nerve 1st","code_information":[{"code":"2202716","type":"CDM"},{"code":"360","type":"RC"},{"code":"64831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Suture Infrapatellar Tendon Primary 1st","code_information":[{"code":"2202718","type":"CDM"},{"code":"360","type":"RC"},{"code":"27380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Thigh Muscle 1st","code_information":[{"code":"2202726","type":"CDM"},{"code":"360","type":"RC"},{"code":"27385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incise Finger Tendon Sheath 1st","code_information":[{"code":"2202738","type":"CDM"},{"code":"360","type":"RC"},{"code":"26055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Transplant Forearm Tendon 1st","code_information":[{"code":"2202740","type":"CDM"},{"code":"360","type":"RC"},{"code":"25310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Tenodesis Long Tendon Biceps 1st","code_information":[{"code":"2202744","type":"CDM"},{"code":"360","type":"RC"},{"code":"23430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Release Hand/finger Tendon 1st","code_information":[{"code":"2202746","type":"CDM"},{"code":"360","type":"RC"},{"code":"26445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Release Of Lower Leg Tendon 1st","code_information":[{"code":"2202750","type":"CDM"},{"code":"360","type":"RC"},{"code":"27680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Tenolysis Flexor Foot Single Tendon 1st","code_information":[{"code":"2202754","type":"CDM"},{"code":"360","type":"RC"},{"code":"28220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Hip Tendons 1st","code_information":[{"code":"2202756","type":"CDM"},{"code":"360","type":"RC"},{"code":"27006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Hip Tendon 1st","code_information":[{"code":"2202758","type":"CDM"},{"code":"360","type":"RC"},{"code":"27000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Elbow Perc 1st","code_information":[{"code":"2202763","type":"CDM"},{"code":"360","type":"RC"},{"code":"24357","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Foot Tendon 1st","code_information":[{"code":"2202769","type":"CDM"},{"code":"360","type":"RC"},{"code":"28234","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Thigh Tendon 1st","code_information":[{"code":"2202772","type":"CDM"},{"code":"360","type":"RC"},{"code":"27390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Foot Tendon(s) 1st","code_information":[{"code":"2202774","type":"CDM"},{"code":"360","type":"RC"},{"code":"28230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Achilles Tendon 1st","code_information":[{"code":"2202778","type":"CDM"},{"code":"360","type":"RC"},{"code":"27606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Achilles Tendon 1st","code_information":[{"code":"2202780","type":"CDM"},{"code":"360","type":"RC"},{"code":"27605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Thigh Tendons 1st","code_information":[{"code":"2202782","type":"CDM"},{"code":"360","type":"RC"},{"code":"27307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Incision Of Thigh Tendon 1st","code_information":[{"code":"2202784","type":"CDM"},{"code":"360","type":"RC"},{"code":"27306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Tenotomy Shoulder Area Single Tendon 1st","code_information":[{"code":"2202786","type":"CDM"},{"code":"360","type":"RC"},{"code":"23405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repeat Thyroid Surgery 1st","code_information":[{"code":"2202792","type":"CDM"},{"code":"360","type":"RC"},{"code":"60260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Thyroidectomy Total Or Complete 1st","code_information":[{"code":"2202794","type":"CDM"},{"code":"360","type":"RC"},{"code":"60240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Thyroid 1st","code_information":[{"code":"2202796","type":"CDM"},{"code":"360","type":"RC"},{"code":"60252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Tonsils And Adenoids 1st","code_information":[{"code":"2202802","type":"CDM"},{"code":"360","type":"RC"},{"code":"42821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal of tonsils and adenoid glands, patient younger than age 12","code_information":[{"code":"2202804","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"42820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Tonsils 1st","code_information":[{"code":"2202806","type":"CDM"},{"code":"360","type":"RC"},{"code":"42826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Removal Of Tonsils 1st","code_information":[{"code":"2202808","type":"CDM"},{"code":"360","type":"RC"},{"code":"42825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Partial Removal Of Thyroid 1st","code_information":[{"code":"2202820","type":"CDM"},{"code":"360","type":"RC"},{"code":"60220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Lower Leg Tendon 1st","code_information":[{"code":"2202827","type":"CDM"},{"code":"360","type":"RC"},{"code":"27691","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Lower Leg Tendon 1st","code_information":[{"code":"2202831","type":"CDM"},{"code":"360","type":"RC"},{"code":"27690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Transplant Hand Tendon 1st","code_information":[{"code":"2202833","type":"CDM"},{"code":"360","type":"RC"},{"code":"26480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Remove Prostate Regrowth 1st","code_information":[{"code":"2202844","type":"CDM"},{"code":"360","type":"RC"},{"code":"52630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Treatment Of Tibia Fracture 1st","code_information":[{"code":"2202862","type":"CDM"},{"code":"360","type":"RC"},{"code":"27759","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Of Eardrum 1st","code_information":[{"code":"2202864","type":"CDM"},{"code":"360","type":"RC"},{"code":"69610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Eardrum Structures 1st","code_information":[{"code":"2202866","type":"CDM"},{"code":"360","type":"RC"},{"code":"69635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Middle Ear & Mastoid 1st","code_information":[{"code":"2202868","type":"CDM"},{"code":"360","type":"RC"},{"code":"69645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Revise Middle Ear & Mastoid 1st","code_information":[{"code":"2202872","type":"CDM"},{"code":"360","type":"RC"},{"code":"69641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Repair Eardrum Structures 1st","code_information":[{"code":"2202874","type":"CDM"},{"code":"360","type":"RC"},{"code":"69631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Perc Lumbar Intravertebral Disc Inj Proc","code_information":[{"code":"2202880","type":"CDM"},{"code":"360","type":"RC"},{"code":"0627T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Unlisted Hysteroscopy Procedure Uterus 1","code_information":[{"code":"2202882","type":"CDM"},{"code":"360","type":"RC"},{"code":"58579","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparo Proc Abdm/per/oment 1st","code_information":[{"code":"2202886","type":"CDM"},{"code":"360","type":"RC"},{"code":"49329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Procedure Bladder 1st","code_information":[{"code":"2202890","type":"CDM"},{"code":"360","type":"RC"},{"code":"51999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscope Proc Intestine 1st","code_information":[{"code":"2202894","type":"CDM"},{"code":"360","type":"RC"},{"code":"44238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Laparoscopy Procedure Stomach 1st","code_information":[{"code":"2202898","type":"CDM"},{"code":"360","type":"RC"},{"code":"43659","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Arthroscopy 1st","code_information":[{"code":"2202903","type":"CDM"},{"code":"360","type":"RC"},{"code":"29999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Esophagus 1st","code_information":[{"code":"2202907","type":"CDM"},{"code":"360","type":"RC"},{"code":"43499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Foot Or Toes 1st","code_information":[{"code":"2202913","type":"CDM"},{"code":"360","type":"RC"},{"code":"28899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Humerus Or Elbow 1st","code_information":[{"code":"2202917","type":"CDM"},{"code":"360","type":"RC"},{"code":"24999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Leg Or Ankle 1st","code_information":[{"code":"2202919","type":"CDM"},{"code":"360","type":"RC"},{"code":"27899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Middle Ear 1st","code_information":[{"code":"2202923","type":"CDM"},{"code":"360","type":"RC"},{"code":"69799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Nose 1st","code_information":[{"code":"2202927","type":"CDM"},{"code":"360","type":"RC"},{"code":"30999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Throat Surgery Procedure 1st","code_information":[{"code":"2202929","type":"CDM"},{"code":"360","type":"RC"},{"code":"42999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Shoulder 1st","code_information":[{"code":"2202931","type":"CDM"},{"code":"360","type":"RC"},{"code":"23929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Procedure Urinary System 1st","code_information":[{"code":"2202937","type":"CDM"},{"code":"360","type":"RC"},{"code":"53899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Vag Hyst Including T/o 1st","code_information":[{"code":"2202955","type":"CDM"},{"code":"360","type":"RC"},{"code":"58262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Vasovasostomy Vasovasorrhaphy 1st","code_information":[{"code":"2202961","type":"CDM"},{"code":"360","type":"RC"},{"code":"55400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Or Level 3 1st 15 Min","code_information":[{"code":"2202982","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202982","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14084,"maximum":14084,"gross_charge":17605,"discounted_cash":17605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14084}]}]},{"description":"Jj 3.5 Lcp Med Proximal Tib Pl","code_information":[{"code":"28007566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14080,"maximum":14080,"gross_charge":17600,"discounted_cash":17600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14080}]}]},{"description":"Angiography Int Mammary Rad Sup&int","code_information":[{"code":"5000010","type":"CDM"},{"code":"320","type":"RC"},{"code":"75756","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14068,"maximum":14068,"gross_charge":17585,"discounted_cash":17585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14068}]}]},{"description":"Angio Pulm Nonslct Cath/ven Inj Rad","code_information":[{"code":"5000013","type":"CDM"},{"code":"320","type":"RC"},{"code":"75746","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14068,"maximum":14068,"gross_charge":17585,"discounted_cash":17585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14068}]}]},{"description":"Percutaneous Transhepatic Portography","code_information":[{"code":"5000131","type":"CDM"},{"code":"320","type":"RC"},{"code":"75887","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14068,"maximum":14068,"gross_charge":17585,"discounted_cash":17585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14068}]}]},{"description":"Venography Caval Sup W/ Serialography","code_information":[{"code":"5000201","type":"CDM"},{"code":"320","type":"RC"},{"code":"75827","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14068,"maximum":14068,"gross_charge":17585,"discounted_cash":17585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14068}]}]},{"description":"Venography Epidural","code_information":[{"code":"5000202","type":"CDM"},{"code":"320","type":"RC"},{"code":"75872","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14068,"maximum":14068,"gross_charge":17585,"discounted_cash":17585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14068}]}]},{"description":"Venography Orbital","code_information":[{"code":"5000205","type":"CDM"},{"code":"320","type":"RC"},{"code":"75880","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14068,"maximum":14068,"gross_charge":17585,"discounted_cash":17585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14068}]}]},{"description":"Venography Venous Sinus","code_information":[{"code":"5000209","type":"CDM"},{"code":"320","type":"RC"},{"code":"75860","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":14068,"maximum":14068,"gross_charge":17585,"discounted_cash":17585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14068}]}]},{"description":"18mm X14mm Xdegree 7x7mmx1","code_information":[{"code":"2800003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14000,"maximum":14000,"gross_charge":17500,"discounted_cash":17500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14000}]}]},{"description":"18mmx14mm X Degree 7x8mm X1","code_information":[{"code":"2800004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14000,"maximum":14000,"gross_charge":17500,"discounted_cash":17500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14000}]}]},{"description":"Evolution Medical 16mm X16mmxdegree 7x6","code_information":[{"code":"2800207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14000,"maximum":14000,"gross_charge":17500,"discounted_cash":17500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14000}]}]},{"description":"Evolution Medical 16mmx13mmx7x6","code_information":[{"code":"2800208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14000,"maximum":14000,"gross_charge":17500,"discounted_cash":17500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14000}]}]},{"description":"Evolution Medical 7x16x13 Lordotic Cage","code_information":[{"code":"2800212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14000,"maximum":14000,"gross_charge":17500,"discounted_cash":17500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14000}]}]},{"description":"Partial Hip","code_information":[{"code":"2800346","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14000,"maximum":14000,"gross_charge":17500,"discounted_cash":17500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14000}]}]},{"description":"Partial Hip Implant","code_information":[{"code":"2800347","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14000,"maximum":14000,"gross_charge":17500,"discounted_cash":17500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14000}]}]},{"description":"Lifenet Health Decellularized Dermis 40x","code_information":[{"code":"2800278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13988,"maximum":13988,"gross_charge":17485,"discounted_cash":17485,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13988},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13988},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13988}]}]},{"description":"Mmedix Epxl Amniotic Membrane Graft","code_information":[{"code":"2800314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13980,"maximum":13980,"gross_charge":17475,"discounted_cash":17475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13980}]}]},{"description":"Lymphangiography Extremity Only Bil Rad","code_information":[{"code":"5000102","type":"CDM"},{"code":"320","type":"RC"},{"code":"75803","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":13825,"maximum":13825,"gross_charge":17281,"discounted_cash":17281,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13825}]}]},{"description":"Lymphangiography Pelvic/abd Bilat Rad","code_information":[{"code":"5000104","type":"CDM"},{"code":"320","type":"RC"},{"code":"75807","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":13825,"maximum":13825,"gross_charge":17281,"discounted_cash":17281,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13825}]}]},{"description":"Lymphangiography Pel/abd Unilateral Rad","code_information":[{"code":"5000105","type":"CDM"},{"code":"320","type":"RC"},{"code":"75805","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":13825,"maximum":13825,"gross_charge":17281,"discounted_cash":17281,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13825}]}]},{"description":"Venography Extremity B/l","code_information":[{"code":"5000203","type":"CDM"},{"code":"320","type":"RC"},{"code":"75822","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":13825,"maximum":13825,"gross_charge":17281,"discounted_cash":17281,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13825}]}]},{"description":"Cartiva 10mm Cartiva Implant (L8699)","code_information":[{"code":"2800136","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13800,"maximum":13800,"gross_charge":17250,"discounted_cash":17250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13800}]}]},{"description":"J&j 10ti Cann Tib Nail Ex Prox Bend 420-","code_information":[{"code":"2802678","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13720,"maximum":13720,"gross_charge":17150,"discounted_cash":17150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13720},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13720},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13720}]}]},{"description":"Genspine Z Link Cervical Spacer 12x15","code_information":[{"code":"2800221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13440,"maximum":13440,"gross_charge":16800,"discounted_cash":16800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13440}]}]},{"description":"Acumed Radial Head","code_information":[{"code":"2800054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13268,"maximum":13268,"gross_charge":16585,"discounted_cash":16585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13268},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13268},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13268}]}]},{"description":"Laparoscopy, Surgical; With Omentopexy (","code_information":[{"code":"22002942","type":"CDM"},{"code":"360","type":"RC"},{"code":"49326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":13194,"gross_charge":16493,"discounted_cash":16493,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13194}]}]},{"description":"Lithotripsy Extracorporeal Shock Wave","code_information":[{"code":"2201792","type":"CDM"},{"code":"790","type":"RC"},{"code":"50590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2200,"maximum":13177,"gross_charge":16471,"discounted_cash":16471,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13177},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13177},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2200}]}]},{"description":"Transluminal Balloon Angioplasty, Centra","code_information":[{"code":"2210142","type":"CDM"},{"code":"360","type":"RC"},{"code":"36907","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":13070,"gross_charge":16338,"discounted_cash":16338,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13070},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13070},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13070}]}]},{"description":"Revascularization, Endovascular, Open Or","code_information":[{"code":"22100010","type":"CDM"},{"code":"360","type":"RC"},{"code":"37220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":13070,"gross_charge":16338,"discounted_cash":16338,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13070},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13070},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13070}]}]},{"description":"New Or Level 1 1st 30 Mins","code_information":[{"code":"12202988","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202988","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12958,"maximum":12958,"gross_charge":16197,"discounted_cash":16197,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12958},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12958},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12958}]}]},{"description":"Depuy Synthes 2.7/3.5mm Distal Tibia Pl/","code_information":[{"code":"2800180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12816,"maximum":12816,"gross_charge":16020,"discounted_cash":16020,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12816},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12816},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12816}]}]},{"description":"3.5 Lcp Med Proximal Tibial Plate 4h","code_information":[{"code":"2800010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12800,"maximum":12800,"gross_charge":16000,"discounted_cash":16000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12800}]}]},{"description":"Mycardiol Perfusion Imaging Tomographic","code_information":[{"code":"5000325","type":"CDM"},{"code":"483","type":"RC"},{"code":"78452","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":950,"maximum":12742,"gross_charge":15927,"discounted_cash":15927,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12742},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12742},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12742},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Pet Limited Study","code_information":[{"code":"5000137","type":"CDM"},{"code":"404","type":"RC"},{"code":"78814","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":12655,"maximum":12655,"gross_charge":15819,"discounted_cash":15819,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12655}]}]},{"description":"Depuy Acetabular Shell Sector 58mm","code_information":[{"code":"2800167","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12594,"maximum":12594,"gross_charge":15743,"discounted_cash":15743,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12594}]}]},{"description":"Depuy 3.5mm Va Lcp Prox Tibia Plate Smal","code_information":[{"code":"2800162","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12540,"maximum":12540,"gross_charge":15675,"discounted_cash":15675,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12540},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12540},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12540}]}]},{"description":"Synthes Va Proximal Tibia Plate","code_information":[{"code":"2800654","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12540,"maximum":12540,"gross_charge":15675,"discounted_cash":15675,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12540},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12540},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12540}]}]},{"description":"Pet Brain Imaging","code_information":[{"code":"5000034","type":"CDM"},{"code":"320","type":"RC"},{"code":"78608","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":12537,"maximum":12537,"gross_charge":15671,"discounted_cash":15671,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12537},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12537},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12537}]}]},{"description":"Synthes 3.5 Lcp Proximal Humerus Plates","code_information":[{"code":"2800596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12512,"maximum":12512,"gross_charge":15640,"discounted_cash":15640,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12512},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12512},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12512}]}]},{"description":"Repair Of Anterior Abdominal Hernia(s) (","code_information":[{"code":"22100001","type":"CDM"},{"code":"360","type":"RC"},{"code":"49594","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":12509,"gross_charge":15636,"discounted_cash":15636,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12509},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12509},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12509}]}]},{"description":"Reverese Liner Retensive","code_information":[{"code":"28003257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12421,"maximum":12421,"gross_charge":15526,"discounted_cash":15526,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12421},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12421},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12421}]}]},{"description":"Selective Catheter Placement, Common Car","code_information":[{"code":"22100006","type":"CDM"},{"code":"360","type":"RC"},{"code":"36223","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":12335,"gross_charge":15419,"discounted_cash":15419,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12335},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12335},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12335}]}]},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"CP17428476722273268","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":12314,"gross_charge":15393,"discounted_cash":15393,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12314}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"CP17428476722276544","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":12261,"gross_charge":15326,"discounted_cash":15326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12261}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"CP17428476722277258","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":12261,"gross_charge":15326,"discounted_cash":15326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12261}]}]},{"description":"Injection(s) of anesthetic into lower spine using imaging guidance","code_information":[{"code":"CP17428476722275007","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":12261,"gross_charge":15326,"discounted_cash":15326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12261}]}]},{"description":"Wright Actishield 4x4cm","code_information":[{"code":"2800700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12242,"maximum":12242,"gross_charge":15302,"discounted_cash":15302,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12242}]}]},{"description":"Merit Medical Stabili Mx Fracture Kit","code_information":[{"code":"2800304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12240,"maximum":12240,"gross_charge":15300,"discounted_cash":15300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12240}]}]},{"description":"Mimedx Amniotic Membrane Allograft 4x4cm","code_information":[{"code":"2800310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12204,"maximum":12204,"gross_charge":15255,"discounted_cash":15255,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12204},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12204},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12204}]}]},{"description":"Genspine 8mm Cervical Interbody Plate","code_information":[{"code":"2800217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12160,"maximum":12160,"gross_charge":15200,"discounted_cash":15200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12160}]}]},{"description":"Exploration For Postoperative Hemorrhage","code_information":[{"code":"2220130","type":"CDM"},{"code":"360","type":"RC"},{"code":"35860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":12148,"gross_charge":15185,"discounted_cash":15185,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12148}]}]},{"description":"Synthes Jj 8 Ti Cann Tibial Nail","code_information":[{"code":"2800637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12060,"maximum":12060,"gross_charge":15075,"discounted_cash":15075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12060},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12060},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12060}]}]},{"description":"Depuy Synthes 2.7mm Medial Diatal Tibia","code_information":[{"code":"2800181","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12044,"maximum":12044,"gross_charge":15055,"discounted_cash":15055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12044},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12044},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12044}]}]},{"description":"Jj 2.7 3.5 Va Lcp Med Distal Tibia Plate","code_information":[{"code":"2800251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12044,"maximum":12044,"gross_charge":15055,"discounted_cash":15055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12044},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12044},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12044}]}]},{"description":"Repair Of Anterior Abdominal Hernia(s) (","code_information":[{"code":"2211546","type":"CDM"},{"code":"360","type":"RC"},{"code":"49617","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":12000,"gross_charge":15000,"discounted_cash":15000,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12000}]}]},{"description":"Corelink Cervical 16.5mm X 14mm X 7mm","code_information":[{"code":"2800139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12000,"maximum":12000,"gross_charge":15000,"discounted_cash":15000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12000}]}]},{"description":"Corelink Cervical 16.5mmx 17mm X 8mm","code_information":[{"code":"2800140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12000,"maximum":12000,"gross_charge":15000,"discounted_cash":15000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12000}]}]},{"description":"Hd Lifesciences Cervical Plate 2levle 32","code_information":[{"code":"2800228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12000,"maximum":12000,"gross_charge":15000,"discounted_cash":15000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12000}]}]},{"description":"Merit Stabili Mx Fracture Kit","code_information":[{"code":"2800305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12000,"maximum":12000,"gross_charge":15000,"discounted_cash":15000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12000}]}]},{"description":"Closure Device, Vascular (Implantable/in","code_information":[{"code":"2811357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12000,"maximum":12000,"gross_charge":15000,"discounted_cash":15000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12000}]}]},{"description":"8mm Barricaid (Annular Closure Device)","code_information":[{"code":"2812788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12000,"maximum":12000,"gross_charge":15000,"discounted_cash":15000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12000}]}]},{"description":"Mild Kit -","code_information":[{"code":"2800307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11980,"maximum":11980,"gross_charge":14975,"discounted_cash":14975,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11980}]}]},{"description":"Io Rad Tx Delivery By Xr","code_information":[{"code":"5000093","type":"CDM"},{"code":"320","type":"RC"},{"code":"77424","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":11673,"maximum":11673,"gross_charge":14591,"discounted_cash":14591,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11673}]}]},{"description":"Trilliant Arsenal Lisfranc Plate","code_information":[{"code":"2800686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11600,"maximum":11600,"gross_charge":14500,"discounted_cash":14500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11600}]}]},{"description":"Tis Trnfr F/c/c/m/n/a/g/h/f 1st","code_information":[{"code":"2200020","type":"CDM"},{"code":"360","type":"RC"},{"code":"14040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Tis Trnfr F/c/c/m/n/a/g/h/f 1st","code_information":[{"code":"2200022","type":"CDM"},{"code":"360","type":"RC"},{"code":"14041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Adjust Bone Fixation Device 1st","code_information":[{"code":"2200030","type":"CDM"},{"code":"360","type":"RC"},{"code":"20693","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Allograft Spine Only Morselized 1st 15","code_information":[{"code":"2200032","type":"CDM"},{"code":"360","type":"RC"},{"code":"20930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Allograft Spine Only Structural 1st 15","code_information":[{"code":"2200034","type":"CDM"},{"code":"360","type":"RC"},{"code":"20931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Amputation Of Finger/thumb 1st","code_information":[{"code":"2200040","type":"CDM"},{"code":"360","type":"RC"},{"code":"26952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Diagnostic Anoscopy Spx 1st","code_information":[{"code":"2200058","type":"CDM"},{"code":"360","type":"RC"},{"code":"46600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Appendectomy 1st","code_information":[{"code":"2200074","type":"CDM"},{"code":"360","type":"RC"},{"code":"44960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Apply Rem Fixation Device 1st","code_information":[{"code":"2200082","type":"CDM"},{"code":"360","type":"RC"},{"code":"20660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Skn Sub Grft F/n/hf/g Child 1st","code_information":[{"code":"2200090","type":"CDM"},{"code":"360","type":"RC"},{"code":"15277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Skin Sub Graft Face/nk/hf/g 1st","code_information":[{"code":"2200092","type":"CDM"},{"code":"360","type":"RC"},{"code":"15275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Application Skin Substitute Graft 1st","code_information":[{"code":"2200094","type":"CDM"},{"code":"360","type":"RC"},{"code":"15276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Appli Skin Subst Graft Trunk Arms Leg 1","code_information":[{"code":"2200096","type":"CDM"},{"code":"360","type":"RC"},{"code":"15274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Skin Sub Grft T/arm/lg Child 1st","code_information":[{"code":"2200098","type":"CDM"},{"code":"360","type":"RC"},{"code":"15273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Application Skin Substitute Graft 1st","code_information":[{"code":"2200100","type":"CDM"},{"code":"360","type":"RC"},{"code":"15272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Skin Sub Graft Trnk/arm/leg 1st","code_information":[{"code":"2200102","type":"CDM"},{"code":"360","type":"RC"},{"code":"15271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Arthroplasty Ipj W/prosthetic Ea Jnt 1st","code_information":[{"code":"2200191","type":"CDM"},{"code":"360","type":"RC"},{"code":"26536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Arthroplasty Mp Joint Each Joint 1st 30","code_information":[{"code":"2200199","type":"CDM"},{"code":"360","type":"RC"},{"code":"26530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200208","type":"CDM"},{"code":"360","type":"RC"},{"code":"29851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Ankle Arthroscopy/surgery 1st","code_information":[{"code":"2200216","type":"CDM"},{"code":"360","type":"RC"},{"code":"29897","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Ankle Arthroscopy/surgery 1st","code_information":[{"code":"2200220","type":"CDM"},{"code":"360","type":"RC"},{"code":"29894","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Ankle Arthroscopy/surgery 1st","code_information":[{"code":"2200222","type":"CDM"},{"code":"360","type":"RC"},{"code":"29891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Hip Arthroscopy Dx 1st","code_information":[{"code":"2200228","type":"CDM"},{"code":"360","type":"RC"},{"code":"29860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Knee Arthroscopy/surgery 1st","code_information":[{"code":"2200244","type":"CDM"},{"code":"360","type":"RC"},{"code":"29876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Arthrotomy W/biopsy Mtp Joint 1st","code_information":[{"code":"2200288","type":"CDM"},{"code":"360","type":"RC"},{"code":"28052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Arthrotomy With Meniscus Repair Knee 1st","code_information":[{"code":"2200290","type":"CDM"},{"code":"360","type":"RC"},{"code":"27403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Explore/treat Ankle Joint 1st","code_information":[{"code":"2200292","type":"CDM"},{"code":"360","type":"RC"},{"code":"27610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Wrist Joint Cartilage 1st","code_information":[{"code":"2200296","type":"CDM"},{"code":"360","type":"RC"},{"code":"25107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Explore/treat Elbow Joint 1st","code_information":[{"code":"2200298","type":"CDM"},{"code":"360","type":"RC"},{"code":"24101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Arthrotomy Elbow With Synovectomy 1st","code_information":[{"code":"2200300","type":"CDM"},{"code":"360","type":"RC"},{"code":"24102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Arthrotomy Hip W/drainage Eg Infect 1st","code_information":[{"code":"2200302","type":"CDM"},{"code":"360","type":"RC"},{"code":"27030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exploration Of Ankle Joint 1st","code_information":[{"code":"2200308","type":"CDM"},{"code":"360","type":"RC"},{"code":"27612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Explore/treat Wrist Joint 1st","code_information":[{"code":"2200316","type":"CDM"},{"code":"360","type":"RC"},{"code":"25101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Aspiration And/or Inj Ganglion Cysts 1st","code_information":[{"code":"2200320","type":"CDM"},{"code":"360","type":"RC"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Autograft Spine Incl Harvst Of Graft 1","code_information":[{"code":"2200328","type":"CDM"},{"code":"360","type":"RC"},{"code":"20936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Autograft For Spine Only Incl Harvest","code_information":[{"code":"2200330","type":"CDM"},{"code":"360","type":"RC"},{"code":"20937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Autograft Spine Incl Harvst Of Graft 1","code_information":[{"code":"2200332","type":"CDM"},{"code":"360","type":"RC"},{"code":"20938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Avulsion Nail Plate Partial Or Comp 1st","code_information":[{"code":"2200334","type":"CDM"},{"code":"360","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Breast W Plcmnt Brst Local Dvc 1s","code_information":[{"code":"2200341","type":"CDM"},{"code":"360","type":"RC"},{"code":"19083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy External Auditory Canal 1st","code_information":[{"code":"2200343","type":"CDM"},{"code":"360","type":"RC"},{"code":"69105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Breast Open Incisional 1st","code_information":[{"code":"2200347","type":"CDM"},{"code":"360","type":"RC"},{"code":"19101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Breast Percutaneous Needle Core 1","code_information":[{"code":"2200349","type":"CDM"},{"code":"360","type":"RC"},{"code":"19100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Liver Needle  1st","code_information":[{"code":"2200351","type":"CDM"},{"code":"360","type":"RC"},{"code":"47001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Penis Separate Procedure 1st","code_information":[{"code":"2200359","type":"CDM"},{"code":"360","type":"RC"},{"code":"54100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Tongue Anterior Two-thirds 1st","code_information":[{"code":"2200361","type":"CDM"},{"code":"360","type":"RC"},{"code":"41100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biop/exc Lymph Node Open Dp Axil Nd  1st","code_information":[{"code":"2200367","type":"CDM"},{"code":"360","type":"RC"},{"code":"38525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biop/exc Lymph Node Open Dp Cerv Nd 1st","code_information":[{"code":"2200369","type":"CDM"},{"code":"360","type":"RC"},{"code":"38510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy/removal Lymph Nodes 1st","code_information":[{"code":"2200371","type":"CDM"},{"code":"360","type":"RC"},{"code":"38530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Bone Open Superficial Troch Fmr 1","code_information":[{"code":"2200376","type":"CDM"},{"code":"360","type":"RC"},{"code":"20240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Intranasal 1st","code_information":[{"code":"2200380","type":"CDM"},{"code":"360","type":"RC"},{"code":"30100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Soft Tissue Neck Or Thorax 1st","code_information":[{"code":"2200384","type":"CDM"},{"code":"360","type":"RC"},{"code":"21550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Soft Tiss Thigh/knee Super 1st","code_information":[{"code":"2200386","type":"CDM"},{"code":"360","type":"RC"},{"code":"27323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Soft Tissue Upper Arm/elbow 1st","code_information":[{"code":"2200388","type":"CDM"},{"code":"360","type":"RC"},{"code":"24066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Vestibule Mouth 1st","code_information":[{"code":"2200390","type":"CDM"},{"code":"360","type":"RC"},{"code":"40808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Biopsy Nasopharynx Visible Lesion Smpl 1","code_information":[{"code":"2200392","type":"CDM"},{"code":"360","type":"RC"},{"code":"42804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Blepharoplasty Lower Eyelid 1st","code_information":[{"code":"2200397","type":"CDM"},{"code":"360","type":"RC"},{"code":"15820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Bone Aspiration Spine Surgery Only 1st","code_information":[{"code":"2200405","type":"CDM"},{"code":"360","type":"RC"},{"code":"20939","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Bone Graft Any Donor Area Major/lrg 1st","code_information":[{"code":"2200407","type":"CDM"},{"code":"360","type":"RC"},{"code":"20902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Bone For Graft 1st","code_information":[{"code":"2200409","type":"CDM"},{"code":"360","type":"RC"},{"code":"20900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Bone Marrow Harvest Transplant Autolog 1","code_information":[{"code":"2200411","type":"CDM"},{"code":"360","type":"RC"},{"code":"38232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Bone Marrow Aspiration Only 1st","code_information":[{"code":"2200413","type":"CDM"},{"code":"360","type":"RC"},{"code":"38220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Breast Diep Or Siea Flap 1st","code_information":[{"code":"2200417","type":"CDM"},{"code":"360","type":"RC"},{"code":"S2068","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Breast Reconstr W/lat Flap 1st","code_information":[{"code":"2200419","type":"CDM"},{"code":"360","type":"RC"},{"code":"19361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Breast Reconstruction 1st","code_information":[{"code":"2200422","type":"CDM"},{"code":"360","type":"RC"},{"code":"19357","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Hip Joint/muscle 1st","code_information":[{"code":"2200428","type":"CDM"},{"code":"360","type":"RC"},{"code":"27036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Capsulec/capsulotomy Ipj Each Jnt 1st 30","code_information":[{"code":"2200430","type":"CDM"},{"code":"360","type":"RC"},{"code":"26525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Capsulect/capsulotomy Mp Joint Ea Jnt 1","code_information":[{"code":"2200432","type":"CDM"},{"code":"360","type":"RC"},{"code":"26520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair/revise Wrist Joint 1st","code_information":[{"code":"2200434","type":"CDM"},{"code":"360","type":"RC"},{"code":"25320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Cautery Cervix Electro Or Thermal 1st","code_information":[{"code":"2200456","type":"CDM"},{"code":"360","type":"RC"},{"code":"57510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Cerclage Cervix During Preg Abd 1st 30 M","code_information":[{"code":"2200460","type":"CDM"},{"code":"360","type":"RC"},{"code":"59325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Cerclage Cervix During Preg Vaginal 1st","code_information":[{"code":"2200462","type":"CDM"},{"code":"360","type":"RC"},{"code":"59320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Lymph Nodes Neck 1st","code_information":[{"code":"2200466","type":"CDM"},{"code":"360","type":"RC"},{"code":"38724","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Circum 28 Days Or Older 1st","code_information":[{"code":"2200479","type":"CDM"},{"code":"360","type":"RC"},{"code":"54161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Circumcision W/regionl Block 1st","code_information":[{"code":"2200481","type":"CDM"},{"code":"360","type":"RC"},{"code":"54150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Finger Fracture Each 1st","code_information":[{"code":"2200487","type":"CDM"},{"code":"360","type":"RC"},{"code":"26742","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Closed Tx Calcaneal Fract W/o Manip 1st","code_information":[{"code":"2200490","type":"CDM"},{"code":"360","type":"RC"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Thumb Fracture 1st","code_information":[{"code":"2200492","type":"CDM"},{"code":"360","type":"RC"},{"code":"26645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Finger Tendon 1st","code_information":[{"code":"2200494","type":"CDM"},{"code":"360","type":"RC"},{"code":"26432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Big Toe Fracture 1st","code_information":[{"code":"2200503","type":"CDM"},{"code":"360","type":"RC"},{"code":"28495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Thigh Fracture 1st","code_information":[{"code":"2200505","type":"CDM"},{"code":"360","type":"RC"},{"code":"27240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Metacarpal Fracture 1st","code_information":[{"code":"2200507","type":"CDM"},{"code":"360","type":"RC"},{"code":"26607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Knuckle Dislocation 1st","code_information":[{"code":"2200509","type":"CDM"},{"code":"360","type":"RC"},{"code":"26705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Closed Tx Metatarsal Frct W/o Manip 1st","code_information":[{"code":"2200511","type":"CDM"},{"code":"360","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Finger Fracture Each 1st","code_information":[{"code":"2200519","type":"CDM"},{"code":"360","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Fracture Radius & Ulna 1st","code_information":[{"code":"2200523","type":"CDM"},{"code":"360","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Dislocation/fracture 1st","code_information":[{"code":"2200529","type":"CDM"},{"code":"360","type":"RC"},{"code":"23665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Shoulder Dislocation 1st","code_information":[{"code":"2200531","type":"CDM"},{"code":"360","type":"RC"},{"code":"23655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Closed Tx Talus Fract W/o Manip 1st","code_information":[{"code":"2200533","type":"CDM"},{"code":"360","type":"RC"},{"code":"28430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Closed Tx Trimall Ankle Frct W/manip 1st","code_information":[{"code":"2200535","type":"CDM"},{"code":"360","type":"RC"},{"code":"27818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treatment Of Ankle Fracture 1st","code_information":[{"code":"2200537","type":"CDM"},{"code":"360","type":"RC"},{"code":"27816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Colonoscopy Stoma W/biop Sng/mlt 1st","code_information":[{"code":"2200557","type":"CDM"},{"code":"360","type":"RC"},{"code":"44389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Colostomy With Biopsies 1st","code_information":[{"code":"2200567","type":"CDM"},{"code":"360","type":"RC"},{"code":"44322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Control Of Nosebleed 1st","code_information":[{"code":"2200594","type":"CDM"},{"code":"360","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Control Nose/throat Bleeding 1st","code_information":[{"code":"2200596","type":"CDM"},{"code":"360","type":"RC"},{"code":"42971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Control Throat Bleeding 1st","code_information":[{"code":"2200598","type":"CDM"},{"code":"360","type":"RC"},{"code":"42960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Of Hammertoe 1st","code_information":[{"code":"2200609","type":"CDM"},{"code":"360","type":"RC"},{"code":"28286","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Bladder & Nodes 1st","code_information":[{"code":"2200623","type":"CDM"},{"code":"360","type":"RC"},{"code":"51585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Debridement Bone Incl Epidermis Dermis 1","code_information":[{"code":"2200739","type":"CDM"},{"code":"360","type":"RC"},{"code":"11047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Debridement Bone 1st 20 Sqcm/< 1st","code_information":[{"code":"2200745","type":"CDM"},{"code":"360","type":"RC"},{"code":"11044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Decompress Forearm 2 Spaces 1st","code_information":[{"code":"2200751","type":"CDM"},{"code":"360","type":"RC"},{"code":"25025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Decompress Forearm 1 Space 1st","code_information":[{"code":"2200755","type":"CDM"},{"code":"360","type":"RC"},{"code":"25020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Delay Flap F/c/c/n/ax/g/h/f 1st","code_information":[{"code":"2200769","type":"CDM"},{"code":"360","type":"RC"},{"code":"15620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Destruct Lesion 15 Or More 1st","code_information":[{"code":"2200773","type":"CDM"},{"code":"360","type":"RC"},{"code":"17111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Destruct B9 Lesion 1-14 1st","code_information":[{"code":"2200775","type":"CDM"},{"code":"360","type":"RC"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Destruction Anal Lesion(s) 1st","code_information":[{"code":"2200789","type":"CDM"},{"code":"360","type":"RC"},{"code":"46924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Destruction Anal Lesion(s) 1st","code_information":[{"code":"2200791","type":"CDM"},{"code":"360","type":"RC"},{"code":"46900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Anal Lesion(s) 1st","code_information":[{"code":"2200793","type":"CDM"},{"code":"360","type":"RC"},{"code":"46922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Laser Surg Penis Lesion(s) 1st","code_information":[{"code":"2200799","type":"CDM"},{"code":"360","type":"RC"},{"code":"54057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Penis Lesion(s) 1st","code_information":[{"code":"2200801","type":"CDM"},{"code":"360","type":"RC"},{"code":"54060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Destroy Vulva Lesion/s Compl 1st","code_information":[{"code":"2200803","type":"CDM"},{"code":"360","type":"RC"},{"code":"56515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"D&c Of Cervical Stump 1st","code_information":[{"code":"2200808","type":"CDM"},{"code":"360","type":"RC"},{"code":"57558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Dilation And Curettage 1st","code_information":[{"code":"2200810","type":"CDM"},{"code":"360","type":"RC"},{"code":"58120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Abscess/hematoma Nasal Septum 1","code_information":[{"code":"2200830","type":"CDM"},{"code":"360","type":"RC"},{"code":"30020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Of Gum Lesion 1st","code_information":[{"code":"2200836","type":"CDM"},{"code":"360","type":"RC"},{"code":"41800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Abdom Abscess Open 1st","code_information":[{"code":"2200842","type":"CDM"},{"code":"360","type":"RC"},{"code":"49020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Dress/debrid P-thick Burn S 1st","code_information":[{"code":"2200854","type":"CDM"},{"code":"360","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Each Add'l 50cc Injectate 1st","code_information":[{"code":"2200856","type":"CDM"},{"code":"360","type":"RC"},{"code":"15772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Electrical Bone Stimulation 1st","code_information":[{"code":"2200858","type":"CDM"},{"code":"360","type":"RC"},{"code":"20974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Endocervical Curettage 1st","code_information":[{"code":"2200864","type":"CDM"},{"code":"360","type":"RC"},{"code":"57505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Endometr Ablate Thermal 1st","code_information":[{"code":"2200866","type":"CDM"},{"code":"360","type":"RC"},{"code":"58353","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Endometrial Sampling Bx W/wo Endocervc 1","code_information":[{"code":"2200868","type":"CDM"},{"code":"360","type":"RC"},{"code":"58100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Hemorrhoid Clot 1st","code_information":[{"code":"2200894","type":"CDM"},{"code":"360","type":"RC"},{"code":"46320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Epididymectomy Unilateral 1st","code_information":[{"code":"2200896","type":"CDM"},{"code":"360","type":"RC"},{"code":"54860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Aural Polyp 1st","code_information":[{"code":"2200930","type":"CDM"},{"code":"360","type":"RC"},{"code":"69540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Neck Cyst 1st","code_information":[{"code":"2200932","type":"CDM"},{"code":"360","type":"RC"},{"code":"42810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revise Hand/finger Tendon 1st","code_information":[{"code":"2200938","type":"CDM"},{"code":"360","type":"RC"},{"code":"26390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excise Inferior Turbinate 1st","code_information":[{"code":"2200940","type":"CDM"},{"code":"360","type":"RC"},{"code":"30130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Bartholin's Gland Or Cyst 1st","code_information":[{"code":"2200942","type":"CDM"},{"code":"360","type":"RC"},{"code":"56740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Chest Wall Tumor Including Ribs 1st","code_information":[{"code":"2200946","type":"CDM"},{"code":"360","type":"RC"},{"code":"19260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal of one or more breast growth, open procedure","code_information":[{"code":"2200948","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"19120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Extraparenchymal Lesion Testis 1st","code_information":[{"code":"2200950","type":"CDM"},{"code":"360","type":"RC"},{"code":"54512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Wrist Tendon Lesion 1st","code_information":[{"code":"2200952","type":"CDM"},{"code":"360","type":"RC"},{"code":"25111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Hydrocele 1st","code_information":[{"code":"2200956","type":"CDM"},{"code":"360","type":"RC"},{"code":"55500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Hydrocele Bilateral 1st","code_information":[{"code":"2200958","type":"CDM"},{"code":"360","type":"RC"},{"code":"55041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Hydrocele Unilateral 1st","code_information":[{"code":"2200960","type":"CDM"},{"code":"360","type":"RC"},{"code":"55040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Knee Cyst 1st","code_information":[{"code":"2200962","type":"CDM"},{"code":"360","type":"RC"},{"code":"27347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excise/repair Mouth Lesion 1st","code_information":[{"code":"2200964","type":"CDM"},{"code":"360","type":"RC"},{"code":"40812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Mouth Lesion 1st","code_information":[{"code":"2200966","type":"CDM"},{"code":"360","type":"RC"},{"code":"40810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Sperm Cord Lesion 1st","code_information":[{"code":"2200968","type":"CDM"},{"code":"360","type":"RC"},{"code":"55520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Tendon Lesion 1st","code_information":[{"code":"2200970","type":"CDM"},{"code":"360","type":"RC"},{"code":"27630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Tendon Sheath Lesion 1st","code_information":[{"code":"2200972","type":"CDM"},{"code":"360","type":"RC"},{"code":"26160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Tongue Lesion 1st","code_information":[{"code":"2200974","type":"CDM"},{"code":"360","type":"RC"},{"code":"41112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Tongue Lesion 1st","code_information":[{"code":"2200976","type":"CDM"},{"code":"360","type":"RC"},{"code":"41113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Tongue Lesion 1st","code_information":[{"code":"2200978","type":"CDM"},{"code":"360","type":"RC"},{"code":"41114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Of Gum Lesion 1st","code_information":[{"code":"2200980","type":"CDM"},{"code":"360","type":"RC"},{"code":"41826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Foot Lesion 1st","code_information":[{"code":"2200982","type":"CDM"},{"code":"360","type":"RC"},{"code":"28090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Toe Lesions 1st","code_information":[{"code":"2200984","type":"CDM"},{"code":"360","type":"RC"},{"code":"28092","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Lingual Frenum Frenectomy 1st","code_information":[{"code":"2200986","type":"CDM"},{"code":"360","type":"RC"},{"code":"41115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Neuroma Digital Nerve 1st","code_information":[{"code":"2200990","type":"CDM"},{"code":"360","type":"RC"},{"code":"64778","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Digit Nerve Lesion 1st","code_information":[{"code":"2200992","type":"CDM"},{"code":"360","type":"RC"},{"code":"64776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Limb Nerve Lesion 1st","code_information":[{"code":"2200994","type":"CDM"},{"code":"360","type":"RC"},{"code":"64782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Nerve Lesion 1st","code_information":[{"code":"2200996","type":"CDM"},{"code":"360","type":"RC"},{"code":"64784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Pilonidal Cyst Compl 1st","code_information":[{"code":"2201004","type":"CDM"},{"code":"360","type":"RC"},{"code":"11772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Pilonidal Cyst Exten 1st","code_information":[{"code":"2201006","type":"CDM"},{"code":"360","type":"RC"},{"code":"11771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Pilonidal Cyst/sinus Simple 1st","code_information":[{"code":"2201008","type":"CDM"},{"code":"360","type":"RC"},{"code":"11770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Rect Tum Transanal Full 1st","code_information":[{"code":"2201010","type":"CDM"},{"code":"360","type":"RC"},{"code":"45172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Rect Tum Transanal Part 1st","code_information":[{"code":"2201012","type":"CDM"},{"code":"360","type":"RC"},{"code":"45171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Sweat Gland Lesion 1st","code_information":[{"code":"2201017","type":"CDM"},{"code":"360","type":"RC"},{"code":"11450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Epididymis Lesion 1st","code_information":[{"code":"2201023","type":"CDM"},{"code":"360","type":"RC"},{"code":"54840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excise Submaxillary Gland 1st","code_information":[{"code":"2201025","type":"CDM"},{"code":"360","type":"RC"},{"code":"42440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Thyroglossal Duct Cyst/sinus 1","code_information":[{"code":"2201030","type":"CDM"},{"code":"360","type":"RC"},{"code":"60280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Vaginal Cyst Or Tumor 1st","code_information":[{"code":"2201034","type":"CDM"},{"code":"360","type":"RC"},{"code":"57135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revise Spermatic Cord Veins 1st","code_information":[{"code":"2201036","type":"CDM"},{"code":"360","type":"RC"},{"code":"55530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revise Hernia & Sperm Veins 1st","code_information":[{"code":"2201038","type":"CDM"},{"code":"360","type":"RC"},{"code":"55540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Hand Bone Lesion 1st","code_information":[{"code":"2201042","type":"CDM"},{"code":"360","type":"RC"},{"code":"26200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Finger Lesion 1st","code_information":[{"code":"2201044","type":"CDM"},{"code":"360","type":"RC"},{"code":"26210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove/graft Foot Lesion 1st","code_information":[{"code":"2201050","type":"CDM"},{"code":"360","type":"RC"},{"code":"28103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove/graft Foot Lesion 1st","code_information":[{"code":"2201054","type":"CDM"},{"code":"360","type":"RC"},{"code":"28107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excise Pharynx Lesion 1st","code_information":[{"code":"2201062","type":"CDM"},{"code":"360","type":"RC"},{"code":"42808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Abd Tum 5 Cm Or Less 1st","code_information":[{"code":"2201064","type":"CDM"},{"code":"360","type":"RC"},{"code":"49203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Eye Lesion 1st","code_information":[{"code":"2201068","type":"CDM"},{"code":"360","type":"RC"},{"code":"65426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Hand Les Sc 1.5 Cm/> 1st","code_information":[{"code":"2201072","type":"CDM"},{"code":"360","type":"RC"},{"code":"26111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Abd Les Sc 3 Cm/> 1st","code_information":[{"code":"2201074","type":"CDM"},{"code":"360","type":"RC"},{"code":"22903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Abd Les Sc < 3 Cm 1st","code_information":[{"code":"2201076","type":"CDM"},{"code":"360","type":"RC"},{"code":"22902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Face Tum Deep < 2 Cm 1st","code_information":[{"code":"2201080","type":"CDM"},{"code":"360","type":"RC"},{"code":"21013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Foot/toe Tum Sc 1.5 Cm/> 1st","code_information":[{"code":"2201082","type":"CDM"},{"code":"360","type":"RC"},{"code":"28039","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Foot/toe Tum Dep 1.5cm/> 1st","code_information":[{"code":"2201084","type":"CDM"},{"code":"360","type":"RC"},{"code":"28041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Forearm Les Sc 3 Cm/> 1st","code_information":[{"code":"2201086","type":"CDM"},{"code":"360","type":"RC"},{"code":"25071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Hip Pelvis Les Sc 3 Cm/>  1st","code_information":[{"code":"2201090","type":"CDM"},{"code":"360","type":"RC"},{"code":"27043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Shoulder Tum Deep 5 Cm/>  1st","code_information":[{"code":"2201092","type":"CDM"},{"code":"360","type":"RC"},{"code":"23073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Arm/elbow Les Sc 3 Cm/>  1st","code_information":[{"code":"2201096","type":"CDM"},{"code":"360","type":"RC"},{"code":"24071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Ex Arm/elbow Tum Deep 5 Cm/>  1st","code_information":[{"code":"2201098","type":"CDM"},{"code":"360","type":"RC"},{"code":"24073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Neck Les Sc < 3 Cm  1st","code_information":[{"code":"2201102","type":"CDM"},{"code":"360","type":"RC"},{"code":"21555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc H-f-nk-sp B9+marg 1.1-4 1st","code_information":[{"code":"2201110","type":"CDM"},{"code":"360","type":"RC"},{"code":"11422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Excessive Skin & Subq Tissue 1s","code_information":[{"code":"2201130","type":"CDM"},{"code":"360","type":"RC"},{"code":"15847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excise Excessive Skin Arm  1st","code_information":[{"code":"2201134","type":"CDM"},{"code":"360","type":"RC"},{"code":"15836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excise Excessive Skin Hip  1st","code_information":[{"code":"2201136","type":"CDM"},{"code":"360","type":"RC"},{"code":"15834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excise Excessive Skin Thigh  1st","code_information":[{"code":"2201142","type":"CDM"},{"code":"360","type":"RC"},{"code":"15832","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Foot Lesion  1st","code_information":[{"code":"2201144","type":"CDM"},{"code":"360","type":"RC"},{"code":"28080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Lesion Mouth Roof  1st","code_information":[{"code":"2201146","type":"CDM"},{"code":"360","type":"RC"},{"code":"42107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Lesion Palate Uvula W/o Closure","code_information":[{"code":"2201148","type":"CDM"},{"code":"360","type":"RC"},{"code":"42104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Wrist Tendon Lesion  1st","code_information":[{"code":"2201150","type":"CDM"},{"code":"360","type":"RC"},{"code":"25110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Tr-ext Mal+marg >4 Cm  1st","code_information":[{"code":"2201169","type":"CDM"},{"code":"360","type":"RC"},{"code":"11606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Nasal Polyps Simple 1st","code_information":[{"code":"2201173","type":"CDM"},{"code":"360","type":"RC"},{"code":"30110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Shoulder Les Sc < 3 Cm  1st","code_information":[{"code":"2201191","type":"CDM"},{"code":"360","type":"RC"},{"code":"23075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Hand Tum Deep < 1.5 Cm  1st","code_information":[{"code":"2201193","type":"CDM"},{"code":"360","type":"RC"},{"code":"26116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Hand Les Sc < 1.5 Cm  1st","code_information":[{"code":"2201195","type":"CDM"},{"code":"360","type":"RC"},{"code":"26115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Foot/toe Tum Deep <1.5cm  1st","code_information":[{"code":"2201197","type":"CDM"},{"code":"360","type":"RC"},{"code":"28045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Tumor Foot Subcutaneous Tissue","code_information":[{"code":"2201199","type":"CDM"},{"code":"360","type":"RC"},{"code":"28043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Leg/ankle Tum < 3 Cm  1st","code_information":[{"code":"2201201","type":"CDM"},{"code":"360","type":"RC"},{"code":"27618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Excision Tumor Soft Tissue Back Or Flank","code_information":[{"code":"2201204","type":"CDM"},{"code":"360","type":"RC"},{"code":"21930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Back Les Sc 3 Cm/>  1st","code_information":[{"code":"2201206","type":"CDM"},{"code":"360","type":"RC"},{"code":"21931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Back Tum Deep 5 Cm/>  1st","code_information":[{"code":"2201208","type":"CDM"},{"code":"360","type":"RC"},{"code":"21933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Back Tum Deep < 5 Cm  1st","code_information":[{"code":"2201210","type":"CDM"},{"code":"360","type":"RC"},{"code":"21932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Face Tum Deep 2 Cm/>  1st","code_information":[{"code":"2201212","type":"CDM"},{"code":"360","type":"RC"},{"code":"21014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Forearm Tum Deep < 3 Cm  1st","code_information":[{"code":"2201218","type":"CDM"},{"code":"360","type":"RC"},{"code":"25076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Forearm Les Sc < 3 Cm  1st","code_information":[{"code":"2201220","type":"CDM"},{"code":"360","type":"RC"},{"code":"25075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Neck Les Sc 3 Cm/>  1st","code_information":[{"code":"2201222","type":"CDM"},{"code":"360","type":"RC"},{"code":"21552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Thigh/knee Les Sc 3 Cm/>  1st","code_information":[{"code":"2201226","type":"CDM"},{"code":"360","type":"RC"},{"code":"27337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Ex Arm/elbow Tum Deep < 5 Cm  1st","code_information":[{"code":"2201228","type":"CDM"},{"code":"360","type":"RC"},{"code":"24076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Arm/elbow Les Sc < 3 Cm  1st","code_information":[{"code":"2201230","type":"CDM"},{"code":"360","type":"RC"},{"code":"24075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Hand Tum Deep 1.5 Cm/>  1st","code_information":[{"code":"2201232","type":"CDM"},{"code":"360","type":"RC"},{"code":"26113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Thigh/knee Tum Deep <5cm  1st","code_information":[{"code":"2201234","type":"CDM"},{"code":"360","type":"RC"},{"code":"27328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exc Thigh/knee Les Sc < 3 Cm  1st","code_information":[{"code":"2201236","type":"CDM"},{"code":"360","type":"RC"},{"code":"27327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exploration For Testis  1st","code_information":[{"code":"2201240","type":"CDM"},{"code":"360","type":"RC"},{"code":"54550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Exploration/repair Of Rectum  1st","code_information":[{"code":"2201250","type":"CDM"},{"code":"360","type":"RC"},{"code":"45562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Release Palm Contracture  1st","code_information":[{"code":"2201262","type":"CDM"},{"code":"360","type":"RC"},{"code":"26123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Fasciectomy Partial Palmar W/release  1s","code_information":[{"code":"2201264","type":"CDM"},{"code":"360","type":"RC"},{"code":"26125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Partial Removal Foot Fascia  1st","code_information":[{"code":"2201266","type":"CDM"},{"code":"360","type":"RC"},{"code":"28060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Foot Fascia  1st","code_information":[{"code":"2201268","type":"CDM"},{"code":"360","type":"RC"},{"code":"28062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Fasciotomy Foot And/or Toe 1st","code_information":[{"code":"2201270","type":"CDM"},{"code":"360","type":"RC"},{"code":"28008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Fasciotomy Hip Or Thigh Any Type 1st","code_information":[{"code":"2201272","type":"CDM"},{"code":"360","type":"RC"},{"code":"27025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Release Palm Contracture  1st","code_information":[{"code":"2201274","type":"CDM"},{"code":"360","type":"RC"},{"code":"26045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Release Palm Contracture  1st","code_information":[{"code":"2201276","type":"CDM"},{"code":"360","type":"RC"},{"code":"26040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Fissurectomy W/wo Sphincterotomy 1st","code_information":[{"code":"2201282","type":"CDM"},{"code":"360","type":"RC"},{"code":"46200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Suspension Of Testis 1st","code_information":[{"code":"2201284","type":"CDM"},{"code":"360","type":"RC"},{"code":"54620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Ther Fx Nasal Inf Turbinate 1st","code_information":[{"code":"2201289","type":"CDM"},{"code":"360","type":"RC"},{"code":"30930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Free Skin Flap Microvasc 1st","code_information":[{"code":"2201291","type":"CDM"},{"code":"360","type":"RC"},{"code":"15757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Reconstruction Tongue Fold 1st","code_information":[{"code":"2201293","type":"CDM"},{"code":"360","type":"RC"},{"code":"41520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Frenulotomy Penis 1st","code_information":[{"code":"2201295","type":"CDM"},{"code":"360","type":"RC"},{"code":"54164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Skin Full Grft Face/genit/hf 1st","code_information":[{"code":"2201297","type":"CDM"},{"code":"360","type":"RC"},{"code":"15240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Skin Full Graft Een & Lips 1st","code_information":[{"code":"2201299","type":"CDM"},{"code":"360","type":"RC"},{"code":"15260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Reconstruction Of Chin 1st","code_information":[{"code":"2201313","type":"CDM"},{"code":"360","type":"RC"},{"code":"21120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Ear Cartilage Graft 1st","code_information":[{"code":"2201315","type":"CDM"},{"code":"360","type":"RC"},{"code":"21235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Grfg Autol Fat Lipo 50 Cc/< 1st","code_information":[{"code":"2201317","type":"CDM"},{"code":"360","type":"RC"},{"code":"15771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Grfg Autol Fat Lipo 25 Cc/< 1st","code_information":[{"code":"2201319","type":"CDM"},{"code":"360","type":"RC"},{"code":"15773","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Grfg Autol Soft Tiss Dir Exc 1st","code_information":[{"code":"2201321","type":"CDM"},{"code":"360","type":"RC"},{"code":"15769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Int Hrhc Tranal Dartlzj 2+ 1st","code_information":[{"code":"2201331","type":"CDM"},{"code":"360","type":"RC"},{"code":"46948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Ligation Of Hemorrhoid(s) 1st","code_information":[{"code":"2201333","type":"CDM"},{"code":"360","type":"RC"},{"code":"46221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove In/ex Hem Groups 2+ 1st","code_information":[{"code":"2201336","type":"CDM"},{"code":"360","type":"RC"},{"code":"46260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove In/ex Hem Grps & Fiss 1st","code_information":[{"code":"2201338","type":"CDM"},{"code":"360","type":"RC"},{"code":"46261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove In/ex Hem Grps W/fist 1st","code_information":[{"code":"2201340","type":"CDM"},{"code":"360","type":"RC"},{"code":"46262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Int/ext Hem 1 Group 1st","code_information":[{"code":"2201342","type":"CDM"},{"code":"360","type":"RC"},{"code":"46255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove In/ex Hem Grp & Fiss 1st","code_information":[{"code":"2201344","type":"CDM"},{"code":"360","type":"RC"},{"code":"46257","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove In/ex Hem Grp W/fistu 1st","code_information":[{"code":"2201346","type":"CDM"},{"code":"360","type":"RC"},{"code":"46258","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Extensive Removal Of Liver 1st","code_information":[{"code":"2201348","type":"CDM"},{"code":"360","type":"RC"},{"code":"47122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Hysteroscopy Dx Sep Proc 1st","code_information":[{"code":"2201350","type":"CDM"},{"code":"360","type":"RC"},{"code":"58555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Hysteroscopy Resect Septum 1st","code_information":[{"code":"2201354","type":"CDM"},{"code":"360","type":"RC"},{"code":"58560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Hysteroscopy Ablation 1st","code_information":[{"code":"2201356","type":"CDM"},{"code":"360","type":"RC"},{"code":"58563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Hysteroscopy Lysis 1st","code_information":[{"code":"2201358","type":"CDM"},{"code":"360","type":"RC"},{"code":"58559","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Hysteroscopy Remove Fb 1st","code_information":[{"code":"2201360","type":"CDM"},{"code":"360","type":"RC"},{"code":"58562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Hysteroscopy W/ Removal Leiomyomata 1st","code_information":[{"code":"2201362","type":"CDM"},{"code":"360","type":"RC"},{"code":"58561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Hysteroscopy Biopsy 1st","code_information":[{"code":"2201364","type":"CDM"},{"code":"360","type":"RC"},{"code":"58558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Implantation Biologic Implant 1st","code_information":[{"code":"2201368","type":"CDM"},{"code":"360","type":"RC"},{"code":"15777","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Of Tonsil Abscess 1st","code_information":[{"code":"2201376","type":"CDM"},{"code":"360","type":"RC"},{"code":"42700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Of Throat Abscess 1st","code_information":[{"code":"2201378","type":"CDM"},{"code":"360","type":"RC"},{"code":"42720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treatment Of Foot Infection 1st","code_information":[{"code":"2201382","type":"CDM"},{"code":"360","type":"RC"},{"code":"28002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Of Gland Abscess 1st","code_information":[{"code":"2201387","type":"CDM"},{"code":"360","type":"RC"},{"code":"56420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Of Scrotum 1st","code_information":[{"code":"2201389","type":"CDM"},{"code":"360","type":"RC"},{"code":"54700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Incision Of Rectal Abscess 1st","code_information":[{"code":"2201393","type":"CDM"},{"code":"360","type":"RC"},{"code":"46045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Incision Of Rectal Abscess 1st","code_information":[{"code":"2201395","type":"CDM"},{"code":"360","type":"RC"},{"code":"46040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"I & D Of Vulva/perineum 1st","code_information":[{"code":"2201402","type":"CDM"},{"code":"360","type":"RC"},{"code":"56405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Complex Drainage Wound  1st","code_information":[{"code":"2201404","type":"CDM"},{"code":"360","type":"RC"},{"code":"10180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drain Thigh/knee Lesion  1st","code_information":[{"code":"2201406","type":"CDM"},{"code":"360","type":"RC"},{"code":"27301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Of Forearm Lesion  1st","code_information":[{"code":"2201408","type":"CDM"},{"code":"360","type":"RC"},{"code":"25028","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drain Lower Leg Lesion  1st","code_information":[{"code":"2201410","type":"CDM"},{"code":"360","type":"RC"},{"code":"27603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"I&d P-spine C/t/cerv-thor  1st","code_information":[{"code":"2201412","type":"CDM"},{"code":"360","type":"RC"},{"code":"22010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Of Pelvis Lesion  1st","code_information":[{"code":"2201416","type":"CDM"},{"code":"360","type":"RC"},{"code":"26990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Incision Of Anal Abscess  1st","code_information":[{"code":"2201418","type":"CDM"},{"code":"360","type":"RC"},{"code":"46050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drain Shoulder Lesion  1st","code_information":[{"code":"2201420","type":"CDM"},{"code":"360","type":"RC"},{"code":"23030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drainage Of Arm Lesion  1st","code_information":[{"code":"2201422","type":"CDM"},{"code":"360","type":"RC"},{"code":"23930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Implant Neuroelectrodes  1st","code_information":[{"code":"2201428","type":"CDM"},{"code":"360","type":"RC"},{"code":"64581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Foot Bone Lesion  1st","code_information":[{"code":"2201430","type":"CDM"},{"code":"360","type":"RC"},{"code":"28005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Incision Of Tendon Sheath  1st","code_information":[{"code":"2201432","type":"CDM"},{"code":"360","type":"RC"},{"code":"25000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Induced Abortion By Dilation&evacuat  1s","code_information":[{"code":"2201436","type":"CDM"},{"code":"360","type":"RC"},{"code":"59841","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Inj Proc -Identification Sentinel Node 1","code_information":[{"code":"2201460","type":"CDM"},{"code":"360","type":"RC"},{"code":"38792","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Insertion Intrauterine Device Iud 1st","code_information":[{"code":"2201550","type":"CDM"},{"code":"360","type":"RC"},{"code":"58300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Insert Tissue Expander(s) 1st","code_information":[{"code":"2201568","type":"CDM"},{"code":"360","type":"RC"},{"code":"11960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Insert Drug Implant Device 1st","code_information":[{"code":"2201581","type":"CDM"},{"code":"360","type":"RC"},{"code":"11981","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treatment Of Penis Lesion 1st","code_information":[{"code":"2201590","type":"CDM"},{"code":"360","type":"RC"},{"code":"54220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Laparoscopy Surg Colpopexy 1st","code_information":[{"code":"2201642","type":"CDM"},{"code":"360","type":"RC"},{"code":"57425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Laparoscopy Adrenalectomy 1st","code_information":[{"code":"2201684","type":"CDM"},{"code":"360","type":"RC"},{"code":"60650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Laparo Ligate Spermatic Vein 1st","code_information":[{"code":"2201686","type":"CDM"},{"code":"360","type":"RC"},{"code":"55550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1868,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Laparo Partial Colectomy 1st","code_information":[{"code":"2201704","type":"CDM"},{"code":"360","type":"RC"},{"code":"44204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Lap Insert Tunnel Ip Cath 1st","code_information":[{"code":"2201722","type":"CDM"},{"code":"360","type":"RC"},{"code":"49324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Diagnostic Laryngoscopy 1st","code_information":[{"code":"2201742","type":"CDM"},{"code":"360","type":"RC"},{"code":"31575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Intmd Rpr Face/mm 20.1-30.0 1st","code_information":[{"code":"2201761","type":"CDM"},{"code":"360","type":"RC"},{"code":"12056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Int Hrhc Lig 2+hroid W/o Img 1st","code_information":[{"code":"2201779","type":"CDM"},{"code":"360","type":"RC"},{"code":"46946","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Int Hrhc Lig 1 Hroid W/o Img 1st","code_information":[{"code":"2201781","type":"CDM"},{"code":"360","type":"RC"},{"code":"46945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Limited Pharyngectomy 1st","code_information":[{"code":"2201787","type":"CDM"},{"code":"360","type":"RC"},{"code":"42890","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Lysis Intranasal Synechia 1st","code_information":[{"code":"2201796","type":"CDM"},{"code":"360","type":"RC"},{"code":"30560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Lysis Penil Circumic Lesion 1st","code_information":[{"code":"2201800","type":"CDM"},{"code":"360","type":"RC"},{"code":"54162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Malar Augmentation Prosthetic Material 1","code_information":[{"code":"2201802","type":"CDM"},{"code":"360","type":"RC"},{"code":"21270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Enlarge Breast With Implant 1st","code_information":[{"code":"2201804","type":"CDM"},{"code":"360","type":"RC"},{"code":"19325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2948,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Fixation Of Knee Joint 1st","code_information":[{"code":"2201808","type":"CDM"},{"code":"360","type":"RC"},{"code":"27570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Fixation Of Shoulder 1st","code_information":[{"code":"2201810","type":"CDM"},{"code":"360","type":"RC"},{"code":"23700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Manipulate Finger W/anesth 1st","code_information":[{"code":"2201812","type":"CDM"},{"code":"360","type":"RC"},{"code":"26340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Drug Delivery Devices Intraarticular 1st","code_information":[{"code":"2201815","type":"CDM"},{"code":"360","type":"RC"},{"code":"20704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Marsupialization Bartholin's Gland Cyst","code_information":[{"code":"2201817","type":"CDM"},{"code":"360","type":"RC"},{"code":"56440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Mastectomy For Gynecomastia1237 1st","code_information":[{"code":"2201819","type":"CDM"},{"code":"360","type":"RC"},{"code":"19300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Mast Mod Rad 1st","code_information":[{"code":"2201821","type":"CDM"},{"code":"360","type":"RC"},{"code":"19307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Partial Mastectomy 1st","code_information":[{"code":"2201823","type":"CDM"},{"code":"360","type":"RC"},{"code":"19301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Mast Radical 1st","code_information":[{"code":"2201827","type":"CDM"},{"code":"360","type":"RC"},{"code":"19305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Mastectomy Simple Complete89718 1st","code_information":[{"code":"2201829","type":"CDM"},{"code":"360","type":"RC"},{"code":"19303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Mastopexy 1st","code_information":[{"code":"2201831","type":"CDM"},{"code":"360","type":"RC"},{"code":"19316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Incision Of Urethra 1st","code_information":[{"code":"2201836","type":"CDM"},{"code":"360","type":"RC"},{"code":"53020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Metatarsectomy 1st","code_information":[{"code":"2201838","type":"CDM"},{"code":"360","type":"RC"},{"code":"28140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Muscle-skin Graft Trunk 1st","code_information":[{"code":"2201846","type":"CDM"},{"code":"360","type":"RC"},{"code":"15734","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Myomectomy Abdom Method 1st","code_information":[{"code":"2201849","type":"CDM"},{"code":"360","type":"RC"},{"code":"58140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Myomectomy Vag Method 1st","code_information":[{"code":"2201851","type":"CDM"},{"code":"360","type":"RC"},{"code":"58145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Nasal/sinus Endoscopy Surg 1st","code_information":[{"code":"2201891","type":"CDM"},{"code":"360","type":"RC"},{"code":"31238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Ovary(s) 1st","code_information":[{"code":"2201941","type":"CDM"},{"code":"360","type":"RC"},{"code":"58940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Open Periprosthetic Capsulotomy Breast 1","code_information":[{"code":"2201943","type":"CDM"},{"code":"360","type":"RC"},{"code":"19370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Elbow Dislocation 1st","code_information":[{"code":"2201949","type":"CDM"},{"code":"360","type":"RC"},{"code":"24615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Wrist Bone Fracture 1st","code_information":[{"code":"2201957","type":"CDM"},{"code":"360","type":"RC"},{"code":"25628","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Opn Tx Orbit Fx W/o Implant 1st","code_information":[{"code":"2201985","type":"CDM"},{"code":"360","type":"RC"},{"code":"21406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Humerus Fracture 1st","code_information":[{"code":"2201999","type":"CDM"},{"code":"360","type":"RC"},{"code":"24579","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Fracture Radius/ulna 1st","code_information":[{"code":"2202035","type":"CDM"},{"code":"360","type":"RC"},{"code":"25575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Fracture Radius & Ulna 1st","code_information":[{"code":"2202037","type":"CDM"},{"code":"360","type":"RC"},{"code":"25574","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treatment Of Ankle Fracture 1st","code_information":[{"code":"2202063","type":"CDM"},{"code":"360","type":"RC"},{"code":"27822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Open Inguinofemoral Nodes 1st","code_information":[{"code":"2202071","type":"CDM"},{"code":"360","type":"RC"},{"code":"38531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Testis 1st","code_information":[{"code":"2202077","type":"CDM"},{"code":"360","type":"RC"},{"code":"54530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Testis 1st","code_information":[{"code":"2202079","type":"CDM"},{"code":"360","type":"RC"},{"code":"54520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revision Of Toe 1st","code_information":[{"code":"2202110","type":"CDM"},{"code":"360","type":"RC"},{"code":"28312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Osteotomy Ulna 1st","code_information":[{"code":"2202130","type":"CDM"},{"code":"360","type":"RC"},{"code":"25360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revise External Ear 1st","code_information":[{"code":"2202132","type":"CDM"},{"code":"360","type":"RC"},{"code":"69300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Partial Removal Of Tibia 1st","code_information":[{"code":"2202144","type":"CDM"},{"code":"360","type":"RC"},{"code":"27640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Partial Removal Finger Bone 1st","code_information":[{"code":"2202152","type":"CDM"},{"code":"360","type":"RC"},{"code":"26236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Fx Distal Radial 1st","code_information":[{"code":"2202182","type":"CDM"},{"code":"360","type":"RC"},{"code":"25606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Pin Radioulnar Dislocation 1st","code_information":[{"code":"2202184","type":"CDM"},{"code":"360","type":"RC"},{"code":"25671","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Pin Finger Dislocation 1st","code_information":[{"code":"2202190","type":"CDM"},{"code":"360","type":"RC"},{"code":"26776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Toe Dislocation 1st","code_information":[{"code":"2202192","type":"CDM"},{"code":"360","type":"RC"},{"code":"28666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Periprosthetic Capsulectomy Breast 1st","code_information":[{"code":"2202222","type":"CDM"},{"code":"360","type":"RC"},{"code":"19371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Peritoneal Lavage 1st","code_information":[{"code":"2202224","type":"CDM"},{"code":"360","type":"RC"},{"code":"49084","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Cover Eye W/membrane Suture 1st","code_information":[{"code":"2202228","type":"CDM"},{"code":"360","type":"RC"},{"code":"65779","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Place Device/marker Non Pro 1st","code_information":[{"code":"2202232","type":"CDM"},{"code":"360","type":"RC"},{"code":"C9728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Placement Seton 1st","code_information":[{"code":"2202236","type":"CDM"},{"code":"360","type":"RC"},{"code":"46020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Open Bowel To Skin 1st","code_information":[{"code":"2202238","type":"CDM"},{"code":"360","type":"RC"},{"code":"44300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Penis Plastic Surgery 1st","code_information":[{"code":"2202240","type":"CDM"},{"code":"360","type":"RC"},{"code":"54360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Rectum & Vagina 1st","code_information":[{"code":"2202242","type":"CDM"},{"code":"360","type":"RC"},{"code":"57250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Correct Rectal Prolapse 1st","code_information":[{"code":"2202250","type":"CDM"},{"code":"360","type":"RC"},{"code":"45541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Of Rectum 1st","code_information":[{"code":"2202252","type":"CDM"},{"code":"360","type":"RC"},{"code":"45505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Proctosigmoidoscopy Dx 1st","code_information":[{"code":"2202254","type":"CDM"},{"code":"360","type":"RC"},{"code":"45300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Radial Styloidectomy Separate Procedure","code_information":[{"code":"2202268","type":"CDM"},{"code":"360","type":"RC"},{"code":"25230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Radical Resect Abd Tumor 5cm/> 1st","code_information":[{"code":"2202274","type":"CDM"},{"code":"360","type":"RC"},{"code":"22905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Radical Resect Abd Tumor<5cm 1st","code_information":[{"code":"2202276","type":"CDM"},{"code":"360","type":"RC"},{"code":"22904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Back Tum 5 Cm/> 1st","code_information":[{"code":"2202278","type":"CDM"},{"code":"360","type":"RC"},{"code":"21936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Foot/toe Tumor 3 Cm/> 1st","code_information":[{"code":"2202280","type":"CDM"},{"code":"360","type":"RC"},{"code":"28047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Forarm/wrist Tum 3cm> 1st","code_information":[{"code":"2202282","type":"CDM"},{"code":"360","type":"RC"},{"code":"25078","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Neck Tumor 5 Cm/> 1st","code_information":[{"code":"2202284","type":"CDM"},{"code":"360","type":"RC"},{"code":"21558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Arm/elbow Tum 5 Cm/> 1st","code_information":[{"code":"2202286","type":"CDM"},{"code":"360","type":"RC"},{"code":"24079","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Back Tum < 5 Cm 1st","code_information":[{"code":"2202288","type":"CDM"},{"code":"360","type":"RC"},{"code":"21935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Face/scalp Tum < 2 Cm 1st","code_information":[{"code":"2202290","type":"CDM"},{"code":"360","type":"RC"},{"code":"21015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Rad Resect Hand Tumor < 3 Cm 1st","code_information":[{"code":"2202293","type":"CDM"},{"code":"360","type":"RC"},{"code":"26117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Neck Thorax Tumor<5cm 1st","code_information":[{"code":"2202295","type":"CDM"},{"code":"360","type":"RC"},{"code":"21557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Resect Thigh/knee Tum < 5 Cm 1st","code_information":[{"code":"2202297","type":"CDM"},{"code":"360","type":"RC"},{"code":"27329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Reconstruct Ulna/radioulnar 1st","code_information":[{"code":"2202301","type":"CDM"},{"code":"360","type":"RC"},{"code":"25337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Deformity Of Toe 1st","code_information":[{"code":"2202311","type":"CDM"},{"code":"360","type":"RC"},{"code":"28313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Hand Joint With Graft 1st","code_information":[{"code":"2202313","type":"CDM"},{"code":"360","type":"RC"},{"code":"26542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Hand Joint With Graft 1st","code_information":[{"code":"2202315","type":"CDM"},{"code":"360","type":"RC"},{"code":"26541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Reduction Mammaplasty 1st","code_information":[{"code":"2202317","type":"CDM"},{"code":"360","type":"RC"},{"code":"19318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Release Thumb Contracture 1st","code_information":[{"code":"2202325","type":"CDM"},{"code":"360","type":"RC"},{"code":"26508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Decompression Of Tibia Nerve 1st","code_information":[{"code":"2202327","type":"CDM"},{"code":"360","type":"RC"},{"code":"28035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Contour Of Face Bone Lesion 1st","code_information":[{"code":"2202335","type":"CDM"},{"code":"360","type":"RC"},{"code":"21029","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Ankle Implant 1st","code_information":[{"code":"2202349","type":"CDM"},{"code":"360","type":"RC"},{"code":"27704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Foreign Body Foot Subcutaneous 1","code_information":[{"code":"2202362","type":"CDM"},{"code":"360","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Arm Foreign Body 1st","code_information":[{"code":"2202364","type":"CDM"},{"code":"360","type":"RC"},{"code":"24200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Implant From Finger Or Hand 1st","code_information":[{"code":"2202368","type":"CDM"},{"code":"360","type":"RC"},{"code":"26320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Support Implant 1st","code_information":[{"code":"2202370","type":"CDM"},{"code":"360","type":"RC"},{"code":"20680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Intact Mammary Implant 1st","code_information":[{"code":"2202374","type":"CDM"},{"code":"360","type":"RC"},{"code":"19328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Knee Prosthesis 1st","code_information":[{"code":"2202388","type":"CDM"},{"code":"360","type":"RC"},{"code":"27488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Remove Drug Implant Device 1st","code_information":[{"code":"2202415","type":"CDM"},{"code":"360","type":"RC"},{"code":"11982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Reconstruct Finger Joint 1st","code_information":[{"code":"2202419","type":"CDM"},{"code":"360","type":"RC"},{"code":"26548","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Blood Vessel Lesion 1st","code_information":[{"code":"2202421","type":"CDM"},{"code":"360","type":"RC"},{"code":"35206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Rpr Rem Hernia Init Reduce 1st","code_information":[{"code":"2202425","type":"CDM"},{"code":"360","type":"RC"},{"code":"49550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repr Elbw Med Ligmnt W/tissu 1st","code_information":[{"code":"2202441","type":"CDM"},{"code":"360","type":"RC"},{"code":"24345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Eyelid Defect 1st","code_information":[{"code":"2202447","type":"CDM"},{"code":"360","type":"RC"},{"code":"67904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Eyelid Defect 1st","code_information":[{"code":"2202449","type":"CDM"},{"code":"360","type":"RC"},{"code":"67908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Brow Defect 1st","code_information":[{"code":"2202451","type":"CDM"},{"code":"360","type":"RC"},{"code":"67900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Spinal Fluid Leakage 1st","code_information":[{"code":"2202459","type":"CDM"},{"code":"360","type":"RC"},{"code":"63707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Entropion Suture 1st","code_information":[{"code":"2202463","type":"CDM"},{"code":"360","type":"RC"},{"code":"67921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Fibula Nonunion 1st","code_information":[{"code":"2202471","type":"CDM"},{"code":"360","type":"RC"},{"code":"27726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Nail Bed 1st","code_information":[{"code":"2202475","type":"CDM"},{"code":"360","type":"RC"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Of Lower Leg 1st","code_information":[{"code":"2202481","type":"CDM"},{"code":"360","type":"RC"},{"code":"27725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Rectocele Separate Procedure 1st","code_information":[{"code":"2202483","type":"CDM"},{"code":"360","type":"RC"},{"code":"45560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Finger/hand Tendon 1st","code_information":[{"code":"2202491","type":"CDM"},{"code":"360","type":"RC"},{"code":"26370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Finger/hand Tendon 1st","code_information":[{"code":"2202497","type":"CDM"},{"code":"360","type":"RC"},{"code":"26350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair/graft Hand Tendon 1st","code_information":[{"code":"2202499","type":"CDM"},{"code":"360","type":"RC"},{"code":"26352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Cmplx Rpr F/c/c/m/n/ax/g/h/f 1st","code_information":[{"code":"2202521","type":"CDM"},{"code":"360","type":"RC"},{"code":"13131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Cmplx Rpr F/c/c/m/n/ax/g/h/f 1st","code_information":[{"code":"2202523","type":"CDM"},{"code":"360","type":"RC"},{"code":"13132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Finger Tendon 1st","code_information":[{"code":"2202537","type":"CDM"},{"code":"360","type":"RC"},{"code":"26418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Laceration Palate Up To 2 Cm 1st","code_information":[{"code":"2202549","type":"CDM"},{"code":"360","type":"RC"},{"code":"42180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Replace G/c Tube Perc 1st","code_information":[{"code":"2202584","type":"CDM"},{"code":"360","type":"RC"},{"code":"49450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Replace Tissue Expander 1st","code_information":[{"code":"2202586","type":"CDM"},{"code":"360","type":"RC"},{"code":"11970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revision Reconstructed Breast 1st","code_information":[{"code":"2202606","type":"CDM"},{"code":"360","type":"RC"},{"code":"19380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revise/remove Neuroelectrode 1st","code_information":[{"code":"2202622","type":"CDM"},{"code":"360","type":"RC"},{"code":"64585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revise/rmv Pn/gastr Stimul 1st","code_information":[{"code":"2202624","type":"CDM"},{"code":"360","type":"RC"},{"code":"64595","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Reconstruction Of Nose 1st","code_information":[{"code":"2202632","type":"CDM"},{"code":"360","type":"RC"},{"code":"30400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Rhytidectomy Cheek Chin And Neck 1st","code_information":[{"code":"2202638","type":"CDM"},{"code":"360","type":"RC"},{"code":"15828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Neck Wrinkles 1st","code_information":[{"code":"2202640","type":"CDM"},{"code":"360","type":"RC"},{"code":"15825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Scrotal Exploration 1st","code_information":[{"code":"2202644","type":"CDM"},{"code":"360","type":"RC"},{"code":"55110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Shave Skin Lesion 0.5 Cm/< 1st","code_information":[{"code":"2202652","type":"CDM"},{"code":"360","type":"RC"},{"code":"11310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Sigmoidoscopy & Polypectomy 1st","code_information":[{"code":"2202661","type":"CDM"},{"code":"360","type":"RC"},{"code":"45333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Slitting Of Prepuce 1st","code_information":[{"code":"2202672","type":"CDM"},{"code":"360","type":"RC"},{"code":"54001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Spinal Puncture Drainage Of Csf 1st","code_information":[{"code":"2202676","type":"CDM"},{"code":"360","type":"RC"},{"code":"62272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Wound Prep F/n/hf/g 1st","code_information":[{"code":"2202698","type":"CDM"},{"code":"360","type":"RC"},{"code":"15004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Surgical Prep Burn Recipient Site 1st","code_information":[{"code":"2202700","type":"CDM"},{"code":"360","type":"RC"},{"code":"15003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Wound Prep Trk/arm/leg 1st","code_information":[{"code":"2202702","type":"CDM"},{"code":"360","type":"RC"},{"code":"15002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Suture Digital Nerve Hand Or Foot  1st","code_information":[{"code":"2202714","type":"CDM"},{"code":"360","type":"RC"},{"code":"64832","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Suture Large Intestine 1st","code_information":[{"code":"2202720","type":"CDM"},{"code":"360","type":"RC"},{"code":"44604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Repair Of Hand Or Foot Nerve 1st","code_information":[{"code":"2202722","type":"CDM"},{"code":"360","type":"RC"},{"code":"64834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Suture One Nerve Ulnar Motor 1st","code_information":[{"code":"2202724","type":"CDM"},{"code":"360","type":"RC"},{"code":"64836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Fusion Of Toes 1st","code_information":[{"code":"2202728","type":"CDM"},{"code":"360","type":"RC"},{"code":"28280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Synovectomy Tendon Sheath Foot Extensor","code_information":[{"code":"2202732","type":"CDM"},{"code":"360","type":"RC"},{"code":"28088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Release Of Lower Leg Tendons 1st","code_information":[{"code":"2202748","type":"CDM"},{"code":"360","type":"RC"},{"code":"27681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Release Palm/finger Tendon 1st","code_information":[{"code":"2202752","type":"CDM"},{"code":"360","type":"RC"},{"code":"26440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Tenotomy Flexor Palm Open Each Tendon 1s","code_information":[{"code":"2202765","type":"CDM"},{"code":"360","type":"RC"},{"code":"26450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Release Of Big Toe 1st","code_information":[{"code":"2202767","type":"CDM"},{"code":"360","type":"RC"},{"code":"28240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Incision Of Toe Tendon 1st","code_information":[{"code":"2202776","type":"CDM"},{"code":"360","type":"RC"},{"code":"28232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Tissue Cultured Epidermal Autograft 1st","code_information":[{"code":"2202798","type":"CDM"},{"code":"360","type":"RC"},{"code":"15157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Tiss Grafts Oth Eg Paratenon Fat Dermis","code_information":[{"code":"2202800","type":"CDM"},{"code":"360","type":"RC"},{"code":"20926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Cervix 1st","code_information":[{"code":"2202822","type":"CDM"},{"code":"360","type":"RC"},{"code":"57530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Incision Of Spinal Nerve 1st","code_information":[{"code":"2202825","type":"CDM"},{"code":"360","type":"RC"},{"code":"64772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Transfer Or Transplant Single Tendon  1s","code_information":[{"code":"2202829","type":"CDM"},{"code":"360","type":"RC"},{"code":"27692","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treatment Incomplete Abortion Surgically","code_information":[{"code":"2202852","type":"CDM"},{"code":"360","type":"RC"},{"code":"59812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Treat Thigh Fracture 1st","code_information":[{"code":"2202854","type":"CDM"},{"code":"360","type":"RC"},{"code":"27245","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Revise Middle Ear & Mastoid 1st","code_information":[{"code":"2202870","type":"CDM"},{"code":"360","type":"RC"},{"code":"69642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Create Eardrum Opening 1st","code_information":[{"code":"2202876","type":"CDM"},{"code":"360","type":"RC"},{"code":"69436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Unlisted Laparoscopic Procedure Liver 1s","code_information":[{"code":"2202884","type":"CDM"},{"code":"360","type":"RC"},{"code":"47379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Laparoscope Proc Biliary 1st","code_information":[{"code":"2202888","type":"CDM"},{"code":"360","type":"RC"},{"code":"47579","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Laparo Proc Hernia Repair 1st","code_information":[{"code":"2202892","type":"CDM"},{"code":"360","type":"RC"},{"code":"49659","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Laparo Proc Spermatic Cord 1st","code_information":[{"code":"2202896","type":"CDM"},{"code":"360","type":"RC"},{"code":"55559","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Procedure Accessory Sinuses 1st","code_information":[{"code":"2202901","type":"CDM"},{"code":"360","type":"RC"},{"code":"31299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Genital Surgery Procedure 1st","code_information":[{"code":"2202909","type":"CDM"},{"code":"360","type":"RC"},{"code":"58999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Procedure Femur Or Knee 1st","code_information":[{"code":"2202911","type":"CDM"},{"code":"360","type":"RC"},{"code":"27599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Procedure Hands Or Fingers 1st","code_information":[{"code":"2202915","type":"CDM"},{"code":"360","type":"RC"},{"code":"26989","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Procedure Male Genital System 1st","code_information":[{"code":"2202921","type":"CDM"},{"code":"360","type":"RC"},{"code":"55899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Procedure Stomach 1st","code_information":[{"code":"2202935","type":"CDM"},{"code":"360","type":"RC"},{"code":"43999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Removal Of Sperm Duct(s) 1st","code_information":[{"code":"2202959","type":"CDM"},{"code":"360","type":"RC"},{"code":"55250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Vulvectomy Simple Partial 1st","code_information":[{"code":"2202979","type":"CDM"},{"code":"360","type":"RC"},{"code":"56620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Xenograft Skin Dermal/temp Wound Close 1","code_information":[{"code":"2202981","type":"CDM"},{"code":"360","type":"RC"},{"code":"15420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Or Level 2 1st 15min","code_information":[{"code":"2202986","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202986","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"Nm Sentinel Node Injection","code_information":[{"code":"5000277","type":"CDM"},{"code":"360","type":"RC"},{"code":"38792","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":11474,"maximum":11474,"gross_charge":14342,"discounted_cash":14342,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11474}]}]},{"description":"J&j 2.7 Medl Dstl Hum Plate","code_information":[{"code":"2800768","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11016,"maximum":11016,"gross_charge":13770,"discounted_cash":13770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11016}]}]},{"description":"J&j Va Lat Hum Plate","code_information":[{"code":"2800772","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11016,"maximum":11016,"gross_charge":13770,"discounted_cash":13770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11016}]}]},{"description":"Myocrd Img Pet Mlt Rst&strs","code_information":[{"code":"5000119","type":"CDM"},{"code":"404","type":"RC"},{"code":"78492","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":10981,"maximum":10981,"gross_charge":13726,"discounted_cash":13726,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10981},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10981},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10981}]}]},{"description":"Stryke Bone Matrix 5cc","code_information":[{"code":"2800416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10800,"maximum":10800,"gross_charge":13500,"discounted_cash":13500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10800}]}]},{"description":"Excision, Tumor, Soft Tissue Of Shoulder","code_information":[{"code":"22012223","type":"CDM"},{"code":"360","type":"RC"},{"code":"23076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":10800,"gross_charge":13500,"discounted_cash":13500,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10800}]}]},{"description":"Synthes 3.5mm Va Lcp Prox Tibia Plates S","code_information":[{"code":"2800608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10736,"maximum":10736,"gross_charge":13420,"discounted_cash":13420,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10736},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10736},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10736}]}]},{"description":"Acumed Rt Olecranor Plate","code_information":[{"code":"2800776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10712,"maximum":10712,"gross_charge":13390,"discounted_cash":13390,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10712}]}]},{"description":"Life Spine Si Screw Lag 8x40mm","code_information":[{"code":"2800274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10664,"maximum":10664,"gross_charge":13330,"discounted_cash":13330,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10664},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10664},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10664}]}]},{"description":"Life Spine Si Tri Fin Screw 12x40mm","code_information":[{"code":"2800275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10664,"maximum":10664,"gross_charge":13330,"discounted_cash":13330,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10664},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10664},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10664}]}]},{"description":"Arthrosurface Hemi Implant 15mm Articula","code_information":[{"code":"2800102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10544,"maximum":10544,"gross_charge":13180,"discounted_cash":13180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10544},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10544},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10544}]}]},{"description":"Myelography Posterior Fossa Rad Sup&int","code_information":[{"code":"2201847","type":"CDM"},{"code":"329","type":"RC"},{"code":"70010","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":10442,"maximum":10442,"gross_charge":13053,"discounted_cash":13053,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10442}]}]},{"description":"Cistern Positive Contrast Rad Sup&int","code_information":[{"code":"5000043","type":"CDM"},{"code":"329","type":"RC"},{"code":"70015","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":10442,"maximum":10442,"gross_charge":13053,"discounted_cash":13053,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10442}]}]},{"description":"Myelography Cervical Rad Sup&int","code_information":[{"code":"5000115","type":"CDM"},{"code":"614","type":"RC"},{"code":"72240","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":10442,"maximum":10442,"gross_charge":13053,"discounted_cash":13053,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10442}]}]},{"description":"Myelography Two Or More Regions","code_information":[{"code":"5000118","type":"CDM"},{"code":"614","type":"RC"},{"code":"72270","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":10442,"maximum":10442,"gross_charge":13053,"discounted_cash":13053,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10442}]}]},{"description":"Depuy Synthes 2.7mm/3.5mm Va Lcp Postlat","code_information":[{"code":"2800187","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10300,"maximum":10300,"gross_charge":12875,"discounted_cash":12875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10300}]}]},{"description":"Depuy Synthes 2.7mm3.5mm Va Lcp Dstl Hum","code_information":[{"code":"2800188","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10300,"maximum":10300,"gross_charge":12875,"discounted_cash":12875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10300}]}]},{"description":"Attune Tibial Insert Rotating Platform 1","code_information":[{"code":"2800113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10192,"maximum":10192,"gross_charge":12740,"discounted_cash":12740,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10192}]}]},{"description":"Attune Tibial Insert Rotating Platform C","code_information":[{"code":"2800114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10192,"maximum":10192,"gross_charge":12740,"discounted_cash":12740,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10192}]}]},{"description":"Depuy Attune Tibial Insert Size 6 7mm Rp","code_information":[{"code":"2800168","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10192,"maximum":10192,"gross_charge":12740,"discounted_cash":12740,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10192}]}]},{"description":"Tibial Insert Rotating Platforms Posteri","code_information":[{"code":"2800665","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10192,"maximum":10192,"gross_charge":12740,"discounted_cash":12740,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10192}]}]},{"description":"Wright Lapidus Locking Plate 0 Degrees","code_information":[{"code":"2800702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10136,"maximum":10136,"gross_charge":12670,"discounted_cash":12670,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10136}]}]},{"description":"Myocrd Img Pet 1std Rst/strs","code_information":[{"code":"5000120","type":"CDM"},{"code":"404","type":"RC"},{"code":"78491","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":10065,"maximum":10065,"gross_charge":12581,"discounted_cash":12581,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10065},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10065},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10065}]}]},{"description":"Ct Abdomen Pelvis With And Without Iv","code_information":[{"code":"5200007","type":"CDM"},{"code":"352","type":"RC"},{"code":"74178","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":10044,"maximum":10044,"gross_charge":12555,"discounted_cash":12555,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10044},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10044},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10044}]}]},{"description":"Removal of recurring cataract in lens capsule using laser","code_information":[{"code":"CP17428476722278116","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"66821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":10043,"gross_charge":12554,"discounted_cash":12554,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10043}]}]},{"description":"Delta Lateralized Glenosphere 38mm","code_information":[{"code":"2800155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10026,"maximum":10026,"gross_charge":12532,"discounted_cash":12532,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10026},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10026},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10026}]}]},{"description":"Axle Cross Bar Plates 40mm","code_information":[{"code":"2800116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10000,"maximum":10000,"gross_charge":12500,"discounted_cash":12500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10000}]}]},{"description":"Axle Locking Plates 40mm, 10mm","code_information":[{"code":"2800117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10000,"maximum":10000,"gross_charge":12500,"discounted_cash":12500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10000}]}]},{"description":"Tactoset Bone Graft","code_information":[{"code":"2800657","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10000,"maximum":10000,"gross_charge":12500,"discounted_cash":12500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10000}]}]},{"description":"Abd Paracentesis W/o Img Guidance 1st 15","code_information":[{"code":"2200002","type":"CDM"},{"code":"360","type":"RC"},{"code":"49082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tis Trnfr Any 30.1-60 Sq Cm 1st","code_information":[{"code":"2200012","type":"CDM"},{"code":"360","type":"RC"},{"code":"14301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Adjacent Tissue Transf/rearrangement 1st","code_information":[{"code":"2200014","type":"CDM"},{"code":"360","type":"RC"},{"code":"14302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tis Trnfr Trnk 10 Sq Cm/< 1st","code_information":[{"code":"2200016","type":"CDM"},{"code":"360","type":"RC"},{"code":"14000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tis Trnfr E/n/e/l 10 Sq Cm/< 1st","code_information":[{"code":"2200018","type":"CDM"},{"code":"360","type":"RC"},{"code":"14060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tis Trnfr S/a/l 10 Sq Cm/< 1st","code_information":[{"code":"2200024","type":"CDM"},{"code":"360","type":"RC"},{"code":"14020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tis Trnfr S/a/l 10.1-30 Sqcm 1st","code_information":[{"code":"2200026","type":"CDM"},{"code":"360","type":"RC"},{"code":"14021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tis Trnfr Trunk 10.1-30sqcm 1st","code_information":[{"code":"2200028","type":"CDM"},{"code":"360","type":"RC"},{"code":"14001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Anorectal Exam Req Anes Dx 1st 15 Min","code_information":[{"code":"2200056","type":"CDM"},{"code":"360","type":"RC"},{"code":"45990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Apply Bone Fixation Device 1st","code_information":[{"code":"2200078","type":"CDM"},{"code":"360","type":"RC"},{"code":"20692","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Apply Bone Fixation Device 1st","code_information":[{"code":"2200080","type":"CDM"},{"code":"360","type":"RC"},{"code":"20690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"App Finger Splint Static 1st","code_information":[{"code":"2200084","type":"CDM"},{"code":"940","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"App Short Arm Splint Frarm-hnd Static 1","code_information":[{"code":"2200086","type":"CDM"},{"code":"360","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"App Short Leg Splint Calf To Foot 1st","code_information":[{"code":"2200088","type":"CDM"},{"code":"940","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Drain/inj Int Joint/bursa W/us 1st","code_information":[{"code":"2200105","type":"CDM"},{"code":"360","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drain/inj Mjr Joint/bursa W/us 1st","code_information":[{"code":"2200107","type":"CDM"},{"code":"360","type":"RC"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drain/inj Sm Joint/bursa W/us 1st","code_information":[{"code":"2200109","type":"CDM"},{"code":"360","type":"RC"},{"code":"20604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drain/inj Mjr Joint/bursa W/o Us 1st","code_information":[{"code":"2200111","type":"CDM"},{"code":"360","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drain/inj Joint/bursa W/o Us 1st","code_information":[{"code":"2200113","type":"CDM"},{"code":"360","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Arthroplast W/pros Replace Dist Rad 1st","code_information":[{"code":"2200177","type":"CDM"},{"code":"360","type":"RC"},{"code":"25441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Arthroscopy Wrist Synovectomy Cmp 1st","code_information":[{"code":"2200286","type":"CDM"},{"code":"360","type":"RC"},{"code":"29845","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Explore/treat Hand Joint 1st","code_information":[{"code":"2200310","type":"CDM"},{"code":"360","type":"RC"},{"code":"26070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Explore/treat Finger Joint 1st","code_information":[{"code":"2200312","type":"CDM"},{"code":"360","type":"RC"},{"code":"26080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Asp & Inj For Tx Bone Cyst 1st 30 Min","code_information":[{"code":"2200318","type":"CDM"},{"code":"360","type":"RC"},{"code":"20615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Aspiration And/or Inj Thyroid Cyst 1st","code_information":[{"code":"2200322","type":"CDM"},{"code":"360","type":"RC"},{"code":"60300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Of Nail Plate 1st","code_information":[{"code":"2200336","type":"CDM"},{"code":"360","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Bx Anorectal Wall Congenital Megacolon 1","code_information":[{"code":"2200345","type":"CDM"},{"code":"360","type":"RC"},{"code":"45100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Biopsy Liver Wedge 1st","code_information":[{"code":"2200353","type":"CDM"},{"code":"360","type":"RC"},{"code":"47100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Bx Hyponychium Prox&lat Nail Folds 1st","code_information":[{"code":"2200355","type":"CDM"},{"code":"360","type":"RC"},{"code":"11755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Biopsy Palate Uvula 1st","code_information":[{"code":"2200357","type":"CDM"},{"code":"360","type":"RC"},{"code":"42100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Biop/exc Lymph Nodes Open Superf 1st","code_information":[{"code":"2200373","type":"CDM"},{"code":"360","type":"RC"},{"code":"38500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Bx Bone Trocar Ndl Deep Verte Bdy Femr 1","code_information":[{"code":"2200378","type":"CDM"},{"code":"360","type":"RC"},{"code":"20225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Biopsy of prostate gland","code_information":[{"code":"2200382","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Biopsy Oropharynx 1st","code_information":[{"code":"2200394","type":"CDM"},{"code":"360","type":"RC"},{"code":"42800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Bone Marrow Biopsy Needle Or Trocar 1st","code_information":[{"code":"2200415","type":"CDM"},{"code":"360","type":"RC"},{"code":"38221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Dx Bronchoscope/wash 1st","code_information":[{"code":"2200424","type":"CDM"},{"code":"360","type":"RC"},{"code":"31622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Carpectomy One Bone 1st","code_information":[{"code":"2200448","type":"CDM"},{"code":"360","type":"RC"},{"code":"25210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Change Gastrostomy Tube Percutaneous 1","code_information":[{"code":"2200468","type":"CDM"},{"code":"360","type":"RC"},{"code":"43760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Treat Fracture Radius/ulna 1st","code_information":[{"code":"2200499","type":"CDM"},{"code":"360","type":"RC"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Closed Tx Nasal Bone Frctr W/o Stabil 1","code_information":[{"code":"2200515","type":"CDM"},{"code":"360","type":"RC"},{"code":"21315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Treat Fracture Radius & Ulna 1st","code_information":[{"code":"2200521","type":"CDM"},{"code":"360","type":"RC"},{"code":"25565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Closed Tx Rad Shaft Fract W/manip 1st","code_information":[{"code":"2200527","type":"CDM"},{"code":"360","type":"RC"},{"code":"25505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Colposcopy Cervix Inc Up/adj Vagina 1st","code_information":[{"code":"2200571","type":"CDM"},{"code":"360","type":"RC"},{"code":"57452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Colpotomy With Exploration 1st","code_information":[{"code":"2200577","type":"CDM"},{"code":"360","type":"RC"},{"code":"57000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Computer-assist Navi Pro Musculo Img 3 1","code_information":[{"code":"2200583","type":"CDM"},{"code":"360","type":"RC"},{"code":"20985","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Contrast Inj Rad Eval Cent Ven Cath 1st","code_information":[{"code":"2200592","type":"CDM"},{"code":"360","type":"RC"},{"code":"36598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Debride Skin At Fx Site 1st","code_information":[{"code":"2200721","type":"CDM"},{"code":"360","type":"RC"},{"code":"11010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Debride Skin Musc At Fx Site 1st","code_information":[{"code":"2200723","type":"CDM"},{"code":"360","type":"RC"},{"code":"11011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Deb Skin Bone At Fx Site 1st","code_information":[{"code":"2200725","type":"CDM"},{"code":"360","type":"RC"},{"code":"11012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Debridement Extensive Eczematous 1st","code_information":[{"code":"2200729","type":"CDM"},{"code":"360","type":"RC"},{"code":"11001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Debride Ext Eczemat/inf Skin>10% Body 1","code_information":[{"code":"2200731","type":"CDM"},{"code":"360","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Debride Genitalia & Perineum 1st","code_information":[{"code":"2200735","type":"CDM"},{"code":"360","type":"RC"},{"code":"11004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Debrd Subq Tissue Incl Epiderm/dermis 1","code_information":[{"code":"2200737","type":"CDM"},{"code":"360","type":"RC"},{"code":"11045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Debridement Skin&subcutaneous Tissue 1st","code_information":[{"code":"2200747","type":"CDM"},{"code":"360","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Destruct Paravertebral Facet Joint Nrv 1","code_information":[{"code":"2200777","type":"CDM"},{"code":"360","type":"RC"},{"code":"64634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Destroy Cerv/thor Facet Jnt 1st","code_information":[{"code":"2200779","type":"CDM"},{"code":"360","type":"RC"},{"code":"64633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Dstrj Nulyt Agt Gnclr Nrv 1st","code_information":[{"code":"2200781","type":"CDM"},{"code":"360","type":"RC"},{"code":"64624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Destruct Paravertebral Facet Joint Nrv 1","code_information":[{"code":"2200783","type":"CDM"},{"code":"360","type":"RC"},{"code":"64636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Destroy Lumb/sac Facet Jnt 1st","code_information":[{"code":"2200785","type":"CDM"},{"code":"360","type":"RC"},{"code":"64635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Injection Treatment Of Nerve 1st","code_information":[{"code":"2200787","type":"CDM"},{"code":"360","type":"RC"},{"code":"64640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Destruction Penis Lesion(s) 1st","code_information":[{"code":"2200797","type":"CDM"},{"code":"360","type":"RC"},{"code":"54050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drain Abscess/hemat Nasal Int Appr 1st","code_information":[{"code":"2200832","type":"CDM"},{"code":"360","type":"RC"},{"code":"30000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drainage Finger Abscess Comp 1st 30 Min","code_information":[{"code":"2200838","type":"CDM"},{"code":"360","type":"RC"},{"code":"26011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drainage Finger Abscess Simple 1st","code_information":[{"code":"2200840","type":"CDM"},{"code":"360","type":"RC"},{"code":"26010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drainage Scrotal Wall Abscess 1st","code_information":[{"code":"2200846","type":"CDM"},{"code":"360","type":"RC"},{"code":"55100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drain Tend Sheath Dgt &/Or Plm Ea 1st","code_information":[{"code":"2200848","type":"CDM"},{"code":"360","type":"RC"},{"code":"26020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Ercp Duct Stent Placement 1st","code_information":[{"code":"2200882","type":"CDM"},{"code":"360","type":"RC"},{"code":"43274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Interlaminar Crv/thrc 1st","code_information":[{"code":"2200898","type":"CDM"},{"code":"360","type":"RC"},{"code":"62325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Interlaminar Crv/thrc 1st","code_information":[{"code":"2200900","type":"CDM"},{"code":"360","type":"RC"},{"code":"62324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Interlaminar Crv/thrc 1st","code_information":[{"code":"2200902","type":"CDM"},{"code":"360","type":"RC"},{"code":"62321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Interlaminar Crv/thrc 1st","code_information":[{"code":"2200904","type":"CDM"},{"code":"360","type":"RC"},{"code":"62320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Interlaminar Lmbr/sac 1st","code_information":[{"code":"2200906","type":"CDM"},{"code":"360","type":"RC"},{"code":"62327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"2200908","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Interlaminar Lmbr/sac 1st","code_information":[{"code":"2200910","type":"CDM"},{"code":"360","type":"RC"},{"code":"62326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"2200912","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Esophagoscopy Rigid Balloon 1st","code_information":[{"code":"2200918","type":"CDM"},{"code":"360","type":"RC"},{"code":"43195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Esophagoscopy Flexible Brush 1st","code_information":[{"code":"2200920","type":"CDM"},{"code":"360","type":"RC"},{"code":"43200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Esophagoscopy Flex Biopsy 1st","code_information":[{"code":"2200922","type":"CDM"},{"code":"360","type":"RC"},{"code":"43202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Esophagoscopy Rigid Trnso Dx 1st","code_information":[{"code":"2200924","type":"CDM"},{"code":"360","type":"RC"},{"code":"43191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Evacuation Subungual Hematoma 1st","code_information":[{"code":"2200926","type":"CDM"},{"code":"360","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove External Ear Partial 1st","code_information":[{"code":"2200936","type":"CDM"},{"code":"360","type":"RC"},{"code":"69110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Excision Breast Lesion 1st 1st","code_information":[{"code":"2200944","type":"CDM"},{"code":"360","type":"RC"},{"code":"19125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Of Nail Bed 1st","code_information":[{"code":"2200988","type":"CDM"},{"code":"360","type":"RC"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Sweat Gland Lesion 1st","code_information":[{"code":"2201015","type":"CDM"},{"code":"360","type":"RC"},{"code":"11451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Sweat Gland Lesion 1st","code_information":[{"code":"2201019","type":"CDM"},{"code":"360","type":"RC"},{"code":"11471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Sweat Gland Lesion 1st","code_information":[{"code":"2201021","type":"CDM"},{"code":"360","type":"RC"},{"code":"11470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Of Knee Cyst 1st","code_information":[{"code":"2201027","type":"CDM"},{"code":"360","type":"RC"},{"code":"27345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Of Urethra Lesion 1st","code_information":[{"code":"2201032","type":"CDM"},{"code":"360","type":"RC"},{"code":"53230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Ear Canal Lesion(s) 1st","code_information":[{"code":"2201070","type":"CDM"},{"code":"360","type":"RC"},{"code":"69145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Thigh/knee Tum Dep 5cm/>  1st","code_information":[{"code":"2201094","type":"CDM"},{"code":"360","type":"RC"},{"code":"27339","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc H-f-nk-sp B9+marg 0.5/<  1st","code_information":[{"code":"2201106","type":"CDM"},{"code":"360","type":"RC"},{"code":"11420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc H-f-nk-sp B9+marg 0.6-1  1st","code_information":[{"code":"2201108","type":"CDM"},{"code":"360","type":"RC"},{"code":"11421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc H-f-nk-sp B9+marg 2.1-5 1st","code_information":[{"code":"2201112","type":"CDM"},{"code":"360","type":"RC"},{"code":"11423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc H-f-nk-sp B9+marg 3.1-6 1st","code_information":[{"code":"2201114","type":"CDM"},{"code":"360","type":"RC"},{"code":"11424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc H-f-nk-sp B9+marg >4 Cm  1st","code_information":[{"code":"2201116","type":"CDM"},{"code":"360","type":"RC"},{"code":"11426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext B9+marg 0.5 Cm<  1st","code_information":[{"code":"2201118","type":"CDM"},{"code":"360","type":"RC"},{"code":"11400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext B9+marg 0.6-1 Cm  1st","code_information":[{"code":"2201120","type":"CDM"},{"code":"360","type":"RC"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext B9+marg 1.1-2 Cm  1st","code_information":[{"code":"2201122","type":"CDM"},{"code":"360","type":"RC"},{"code":"11402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext B9+marg 2.1-3cm  1st","code_information":[{"code":"2201124","type":"CDM"},{"code":"360","type":"RC"},{"code":"11403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext B9+marg 3.1-4 Cm  1st","code_information":[{"code":"2201126","type":"CDM"},{"code":"360","type":"RC"},{"code":"11404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext B9+marg >4.0 Cm  1st","code_information":[{"code":"2201128","type":"CDM"},{"code":"360","type":"RC"},{"code":"11406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc F/e/e/n/l Mal+mrg 0.6-1 1st","code_information":[{"code":"2201152","type":"CDM"},{"code":"360","type":"RC"},{"code":"11641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc F/e/e/n/l Mal+mrg 1.1-2 1st","code_information":[{"code":"2201154","type":"CDM"},{"code":"360","type":"RC"},{"code":"11642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc F/e/e/n/l Mal+mrg 3.1-4 1st","code_information":[{"code":"2201156","type":"CDM"},{"code":"360","type":"RC"},{"code":"11644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc S/n/h/f/g Mal+mrg 1.1-2 1st","code_information":[{"code":"2201159","type":"CDM"},{"code":"360","type":"RC"},{"code":"11622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc S/n/h/f/g Mal+mrg >4 Cm  1st","code_information":[{"code":"2201161","type":"CDM"},{"code":"360","type":"RC"},{"code":"11626","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext Mal+marg 1.1-2 Cm  1st","code_information":[{"code":"2201163","type":"CDM"},{"code":"360","type":"RC"},{"code":"11602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext Mal+marg 2.1-3 Cm  1st","code_information":[{"code":"2201165","type":"CDM"},{"code":"360","type":"RC"},{"code":"11603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Tr-ext Mal+marg 3.1-4 Cm  1st","code_information":[{"code":"2201167","type":"CDM"},{"code":"360","type":"RC"},{"code":"11604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Face-mm B9+marg 0.5 Cm/<  1st","code_information":[{"code":"2201177","type":"CDM"},{"code":"360","type":"RC"},{"code":"11440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Face-mm B9+marg 0.6-1 Cm  1st","code_information":[{"code":"2201179","type":"CDM"},{"code":"360","type":"RC"},{"code":"11441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Face-mm B9+marg 1.1-2 Cm  1st","code_information":[{"code":"2201181","type":"CDM"},{"code":"360","type":"RC"},{"code":"11442","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Face-mm B9+marg 2.1-3 Cm  1st","code_information":[{"code":"2201183","type":"CDM"},{"code":"360","type":"RC"},{"code":"11443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Face-mm B9+marg 3.1-4 Cm  1st","code_information":[{"code":"2201185","type":"CDM"},{"code":"360","type":"RC"},{"code":"11444","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Face-mm B9+marg >4 Cm  1st","code_information":[{"code":"2201187","type":"CDM"},{"code":"360","type":"RC"},{"code":"11446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Face Les Sbq 2 Cm/>  1st","code_information":[{"code":"2201214","type":"CDM"},{"code":"360","type":"RC"},{"code":"21012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exc Face Les Sc <2 Cm  1st","code_information":[{"code":"2201216","type":"CDM"},{"code":"360","type":"RC"},{"code":"21011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Explore Wound Extremity  1st","code_information":[{"code":"2201244","type":"CDM"},{"code":"360","type":"RC"},{"code":"20103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Exploration Behind Abdomen  1st","code_information":[{"code":"2201252","type":"CDM"},{"code":"360","type":"RC"},{"code":"49010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Fine Needle Asp W Imag Guidance 1st","code_information":[{"code":"2201278","type":"CDM"},{"code":"360","type":"RC"},{"code":"10022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Fine Needle Asp Wo Imag Guidance 1st","code_information":[{"code":"2201280","type":"CDM"},{"code":"360","type":"RC"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Gnclr Nrv Brnch 1st","code_information":[{"code":"2201311","type":"CDM"},{"code":"360","type":"RC"},{"code":"64454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Treatment Of Foot Infection 1st","code_information":[{"code":"2201380","type":"CDM"},{"code":"360","type":"RC"},{"code":"28003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drainage Of Skin Abscess 1st","code_information":[{"code":"2201383","type":"CDM"},{"code":"360","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drainage Of Skin Abscess 1st","code_information":[{"code":"2201385","type":"CDM"},{"code":"360","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drainage Of Hematoma/fluid 1","code_information":[{"code":"2201391","type":"CDM"},{"code":"360","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Incision Of Rectal Abscess 1st","code_information":[{"code":"2201397","type":"CDM"},{"code":"360","type":"RC"},{"code":"46060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Drainage Of Rectal Abscess 1st","code_information":[{"code":"2201400","type":"CDM"},{"code":"360","type":"RC"},{"code":"45005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Foreign Body 1st","code_information":[{"code":"2201424","type":"CDM"},{"code":"360","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Foreign Body 1st","code_information":[{"code":"2201426","type":"CDM"},{"code":"360","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Nrv Nrvtg Si Jt 1st","code_information":[{"code":"2201441","type":"CDM"},{"code":"360","type":"RC"},{"code":"64451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Proc Cystograph/urethrocystography 1","code_information":[{"code":"2201445","type":"CDM"},{"code":"360","type":"RC"},{"code":"51600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inject Proc Disco Ea Level Cerv/thor  1s","code_information":[{"code":"2201447","type":"CDM"},{"code":"360","type":"RC"},{"code":"62291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Proc Discography Ea Lvl Lumbar  1st","code_information":[{"code":"2201449","type":"CDM"},{"code":"360","type":"RC"},{"code":"62290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Proc Hip Arthrography With Anes  1st","code_information":[{"code":"2201451","type":"CDM"},{"code":"360","type":"RC"},{"code":"27095","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Proc For Hip Arthrography W/o Anes","code_information":[{"code":"2201453","type":"CDM"},{"code":"360","type":"RC"},{"code":"27093","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inject Sacroiliac Joint  1st","code_information":[{"code":"2201456","type":"CDM"},{"code":"360","type":"RC"},{"code":"27096","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj For Sacroiliac Jt Anesth  1st","code_information":[{"code":"2201458","type":"CDM"},{"code":"360","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Injection Procedure Lymphangiography  1s","code_information":[{"code":"2201462","type":"CDM"},{"code":"360","type":"RC"},{"code":"38790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"N Block Inj Plantar Digit  1st","code_information":[{"code":"2201464","type":"CDM"},{"code":"360","type":"RC"},{"code":"64455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Paravertebral Facet Zygapop 1st","code_information":[{"code":"2201466","type":"CDM"},{"code":"360","type":"RC"},{"code":"64491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Paravert F Jnt C/t 1 Lev 1st","code_information":[{"code":"2201468","type":"CDM"},{"code":"360","type":"RC"},{"code":"64490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Paravrtbrl Facet Zygapophyseal Jnt","code_information":[{"code":"2201470","type":"CDM"},{"code":"360","type":"RC"},{"code":"64492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Paravertebral Joint 2nd Level 1st","code_information":[{"code":"2201472","type":"CDM"},{"code":"360","type":"RC"},{"code":"64494","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Paravert F Jnt L/s 1 Lev 1st","code_information":[{"code":"2201474","type":"CDM"},{"code":"360","type":"RC"},{"code":"64493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Paravrtbrl Facet Zygapophyseal Jnt 1","code_information":[{"code":"2201476","type":"CDM"},{"code":"360","type":"RC"},{"code":"64495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Trigger Point 1/2 Muscl  1st","code_information":[{"code":"2201480","type":"CDM"},{"code":"360","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inject Trigger Points 3/>  1st","code_information":[{"code":"2201482","type":"CDM"},{"code":"360","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Tendon Origin/insertion  1st","code_information":[{"code":"2201484","type":"CDM"},{"code":"360","type":"RC"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Tendon Sheath/ligament  1st","code_information":[{"code":"2201486","type":"CDM"},{"code":"360","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inject Anestheti Agent And/or Steroid 1s","code_information":[{"code":"2201488","type":"CDM"},{"code":"360","type":"RC"},{"code":"64480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Foramen Epidural C/t  1st","code_information":[{"code":"2201490","type":"CDM"},{"code":"360","type":"RC"},{"code":"64479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Agent And/or Steroid Epidural  1st","code_information":[{"code":"2201492","type":"CDM"},{"code":"360","type":"RC"},{"code":"64484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Injection(s) of anesthetic into lower spine using imaging guidance","code_information":[{"code":"2201494","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Axillary Nrv  1st","code_information":[{"code":"2201496","type":"CDM"},{"code":"360","type":"RC"},{"code":"64417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Brach Plexus  1st","code_information":[{"code":"2201498","type":"CDM"},{"code":"360","type":"RC"},{"code":"64415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inj Anesthetic Agent Carotid Sinus  1st","code_information":[{"code":"2201500","type":"CDM"},{"code":"360","type":"RC"},{"code":"64508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"N Block Inj Celiac Pelus  1st","code_information":[{"code":"2201502","type":"CDM"},{"code":"360","type":"RC"},{"code":"64530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Fem Nerve Nfs  1st","code_information":[{"code":"2201504","type":"CDM"},{"code":"360","type":"RC"},{"code":"64448","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Femoral Nerve  1st","code_information":[{"code":"2201506","type":"CDM"},{"code":"360","type":"RC"},{"code":"64447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Gr Ocpl Nrv  1st","code_information":[{"code":"2201508","type":"CDM"},{"code":"360","type":"RC"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Ii Ih Nerves  1st","code_information":[{"code":"2201510","type":"CDM"},{"code":"360","type":"RC"},{"code":"64425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Ntrcost Nrv  1st","code_information":[{"code":"2201512","type":"CDM"},{"code":"360","type":"RC"},{"code":"64420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inject Intercostal Nrvs Mult Reg Block","code_information":[{"code":"2201514","type":"CDM"},{"code":"360","type":"RC"},{"code":"64421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"N Block Lumbar/thoracic  1st","code_information":[{"code":"2201516","type":"CDM"},{"code":"360","type":"RC"},{"code":"64520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Other Pn/branch  1st","code_information":[{"code":"2201518","type":"CDM"},{"code":"360","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Sciatic Nerve  1st","code_information":[{"code":"2201520","type":"CDM"},{"code":"360","type":"RC"},{"code":"64445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"N Block Spenopalatine Gangl  1st","code_information":[{"code":"2201522","type":"CDM"},{"code":"360","type":"RC"},{"code":"64505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"N Block Stellate Ganglion  1st","code_information":[{"code":"2201524","type":"CDM"},{"code":"360","type":"RC"},{"code":"64510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"N Block Inj Hypogas Plxs  1st","code_information":[{"code":"2201526","type":"CDM"},{"code":"360","type":"RC"},{"code":"64517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Sprscap Nrv  1st","code_information":[{"code":"2201528","type":"CDM"},{"code":"360","type":"RC"},{"code":"64418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Njx Aa&/strd Trigeminal Nrv  1st","code_information":[{"code":"2201530","type":"CDM"},{"code":"360","type":"RC"},{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Injection Epidural Blood Or Clot Patch","code_information":[{"code":"2201532","type":"CDM"},{"code":"360","type":"RC"},{"code":"62273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inject Skin Lesions >7 1st","code_information":[{"code":"2201534","type":"CDM"},{"code":"360","type":"RC"},{"code":"11901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Inject Skin Lesions </W 7 1st","code_information":[{"code":"2201536","type":"CDM"},{"code":"360","type":"RC"},{"code":"11900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Ther Injection Carp Tunnel  1st","code_information":[{"code":"2201538","type":"CDM"},{"code":"360","type":"RC"},{"code":"20526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Place Duod/jej Tube Perc  1st","code_information":[{"code":"2201540","type":"CDM"},{"code":"360","type":"RC"},{"code":"49441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Place Gastrostomy Tube Perc  1st","code_information":[{"code":"2201542","type":"CDM"},{"code":"360","type":"RC"},{"code":"49440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Ins Endovas Vena Cava Filtr 1st","code_information":[{"code":"2201552","type":"CDM"},{"code":"360","type":"RC"},{"code":"37191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Insert Bladder Catheter 1st","code_information":[{"code":"2201556","type":"CDM"},{"code":"360","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Insertion Subcutaneous Extension 1st","code_information":[{"code":"2201564","type":"CDM"},{"code":"360","type":"RC"},{"code":"49435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Insert Tunneled Cv Cath 1st","code_information":[{"code":"2201574","type":"CDM"},{"code":"360","type":"RC"},{"code":"36558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intraop Id Mapping Sentinel Lymph Node 1","code_information":[{"code":"2201585","type":"CDM"},{"code":"360","type":"RC"},{"code":"38900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Test For Blood Flow In Graft 1st","code_information":[{"code":"2201587","type":"CDM"},{"code":"360","type":"RC"},{"code":"15860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Incise Inner Ear 1st","code_information":[{"code":"2201592","type":"CDM"},{"code":"360","type":"RC"},{"code":"69801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Laryngoscop W/vc Inj + Scope 1st","code_information":[{"code":"2201740","type":"CDM"},{"code":"360","type":"RC"},{"code":"31571","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Diagnostic Laryngoscopy 1st","code_information":[{"code":"2201744","type":"CDM"},{"code":"360","type":"RC"},{"code":"31505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr Face/mm 12.6-20 Cm  1st","code_information":[{"code":"2201755","type":"CDM"},{"code":"360","type":"RC"},{"code":"12055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr Face/mm 2.5 Cm/<  1st","code_information":[{"code":"2201757","type":"CDM"},{"code":"360","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr Face/mm 2.6-5.0 Cm  1st","code_information":[{"code":"2201759","type":"CDM"},{"code":"360","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr Face/mm 5.1-7.5 Cm  1st","code_information":[{"code":"2201763","type":"CDM"},{"code":"360","type":"RC"},{"code":"12053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr N-hf/genit 2.5cm/<  1st","code_information":[{"code":"2201765","type":"CDM"},{"code":"360","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr N-hf/genit2.6-7.5 1st","code_information":[{"code":"2201767","type":"CDM"},{"code":"360","type":"RC"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr N-hf/genit7.6-12.5 1st","code_information":[{"code":"2201769","type":"CDM"},{"code":"360","type":"RC"},{"code":"12044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr S/a/t/ext 2.5 Cm/<  1st","code_information":[{"code":"2201771","type":"CDM"},{"code":"360","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr S/tr/ext 7.6-12.5 1st","code_information":[{"code":"2201773","type":"CDM"},{"code":"360","type":"RC"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Ligation Or Biopsy Temporal Artery 1st","code_information":[{"code":"2201783","type":"CDM"},{"code":"360","type":"RC"},{"code":"37609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Incision Of Breast Lesion 1st","code_information":[{"code":"2201833","type":"CDM"},{"code":"360","type":"RC"},{"code":"19020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Microsurgical Techniques W/microscope 1s","code_information":[{"code":"2201840","type":"CDM"},{"code":"360","type":"RC"},{"code":"69990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Incision Of Eardrum 1st","code_information":[{"code":"2201858","type":"CDM"},{"code":"360","type":"RC"},{"code":"69421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Placement Breast Localization Devices 1s","code_information":[{"code":"2202230","type":"CDM"},{"code":"360","type":"RC"},{"code":"19285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Place Ndl Musc/tis For Rt 1st","code_information":[{"code":"2202234","type":"CDM"},{"code":"360","type":"RC"},{"code":"20555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Punch Biopsy With Simple Closer 1st","code_information":[{"code":"2202259","type":"CDM"},{"code":"360","type":"RC"},{"code":"11104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Puncture Aspiration Of Abscess 1st","code_information":[{"code":"2202261","type":"CDM"},{"code":"360","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Puncture Aspiration Cyst Breast 1st","code_information":[{"code":"2202263","type":"CDM"},{"code":"360","type":"RC"},{"code":"19000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Brain Canal Shunt Procedure 1st","code_information":[{"code":"2202265","type":"CDM"},{"code":"360","type":"RC"},{"code":"61070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Extensive Surgery Of Throat 1st","code_information":[{"code":"2202272","type":"CDM"},{"code":"360","type":"RC"},{"code":"42842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Reconstruction Nail Bed With Graft 1st","code_information":[{"code":"2202309","type":"CDM"},{"code":"360","type":"RC"},{"code":"11762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Clear Outer Ear Canal 1st","code_information":[{"code":"2202339","type":"CDM"},{"code":"360","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Nasal Foreign Body 1st","code_information":[{"code":"2202341","type":"CDM"},{"code":"360","type":"RC"},{"code":"30310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Impacted Ear Wax Uni 1st","code_information":[{"code":"2202343","type":"CDM"},{"code":"360","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Impacted Ear Wax Uni 1st","code_information":[{"code":"2202345","type":"CDM"},{"code":"360","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Of Corneal Epithelium 1st","code_information":[{"code":"2202353","type":"CDM"},{"code":"360","type":"RC"},{"code":"65436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Of Foreign Body Musc/tdn Spl 1st","code_information":[{"code":"2202356","type":"CDM"},{"code":"360","type":"RC"},{"code":"20520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Intrauterine Device Iud 1st","code_information":[{"code":"2202376","type":"CDM"},{"code":"360","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Tunneled Ip Cath 1st","code_information":[{"code":"2202380","type":"CDM"},{"code":"360","type":"RC"},{"code":"49422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Rem Mesh Abdominal Wall For Infection 1s","code_information":[{"code":"2202390","type":"CDM"},{"code":"360","type":"RC"},{"code":"11008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Skin Tags Mult Fibrocut  1st","code_information":[{"code":"2202392","type":"CDM"},{"code":"360","type":"RC"},{"code":"11201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Removal Of Skin Tags <W/18 1st","code_information":[{"code":"2202394","type":"CDM"},{"code":"360","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Sutures Diff Surgeon  1st","code_information":[{"code":"2202402","type":"CDM"},{"code":"360","type":"RC"},{"code":"15851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Tissue Expander(s) 1st","code_information":[{"code":"2202405","type":"CDM"},{"code":"360","type":"RC"},{"code":"11971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Repair Lip Full Thickness Vermilion Only","code_information":[{"code":"2202437","type":"CDM"},{"code":"360","type":"RC"},{"code":"40650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Cmplx Rpr E/n/e/l 1.1-2.5 Cm 1st","code_information":[{"code":"2202515","type":"CDM"},{"code":"360","type":"RC"},{"code":"13151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Cmplx Rpr E/n/e/l 2.6-7.5 Cm 1st","code_information":[{"code":"2202517","type":"CDM"},{"code":"360","type":"RC"},{"code":"13152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Repair Complex Area 5 Cm Or Less 1st","code_information":[{"code":"2202519","type":"CDM"},{"code":"360","type":"RC"},{"code":"13153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Cmplx Rpr S/a/l 2.6-7.5 Cm 1st","code_information":[{"code":"2202525","type":"CDM"},{"code":"360","type":"RC"},{"code":"13121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Repair Complex Trunk 1.1 Cm To 2.5 Cm 1s","code_information":[{"code":"2202527","type":"CDM"},{"code":"360","type":"RC"},{"code":"13100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Repair Complex Trunk 2.6 Cm To 7.5 Cm 1s","code_information":[{"code":"2202529","type":"CDM"},{"code":"360","type":"RC"},{"code":"13101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Repair Complex Trunk Each Add <5 Cm 1st","code_information":[{"code":"2202531","type":"CDM"},{"code":"360","type":"RC"},{"code":"13102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Intmd Rpr S/a/t/ext 2.6-7.5 Cm 1st","code_information":[{"code":"2202545","type":"CDM"},{"code":"360","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Rfa Sacroiliac Joint W/ Image Guidance 1","code_information":[{"code":"2202626","type":"CDM"},{"code":"360","type":"RC"},{"code":"64625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Sigmoidoscopy W/submuc Inj 1st","code_information":[{"code":"2202658","type":"CDM"},{"code":"360","type":"RC"},{"code":"45335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Rpr F/e/e/n/l/m 2.5 Cm/< 1st","code_information":[{"code":"2202663","type":"CDM"},{"code":"360","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Rpr S/n/ax/gen/trnk 2.5cm/< 1st","code_information":[{"code":"2202665","type":"CDM"},{"code":"360","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Rpr S/n/ax/gen/trnk2.6-7.5cm 1st","code_information":[{"code":"2202667","type":"CDM"},{"code":"360","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Ther Spi Pnxr Csf Fluor/ct 1st","code_information":[{"code":"2202674","type":"CDM"},{"code":"360","type":"RC"},{"code":"62329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Strapping Unna Boot 1st","code_information":[{"code":"2202684","type":"CDM"},{"code":"940","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Tenodesis At Wrist Extensors Fingers 1st","code_information":[{"code":"2202742","type":"CDM"},{"code":"360","type":"RC"},{"code":"25301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Stereotactic Ca Cranial Extradural 1st","code_information":[{"code":"2202788","type":"CDM"},{"code":"360","type":"RC"},{"code":"61782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Aspirate Pleura W/ Imaging","code_information":[{"code":"2202790","type":"CDM"},{"code":"360","type":"RC"},{"code":"32555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Revision Of Bladder Neck 1st","code_information":[{"code":"2202842","type":"CDM"},{"code":"360","type":"RC"},{"code":"52500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tap Block Bi Injection 1st","code_information":[{"code":"2202846","type":"CDM"},{"code":"360","type":"RC"},{"code":"64488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tap Block Uni By Infusion 1st","code_information":[{"code":"2202848","type":"CDM"},{"code":"360","type":"RC"},{"code":"64487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Tap Block Bi By Infusion 1st","code_information":[{"code":"2202850","type":"CDM"},{"code":"360","type":"RC"},{"code":"64489","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Care Of Miscarriage 1st","code_information":[{"code":"2202856","type":"CDM"},{"code":"360","type":"RC"},{"code":"59820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Treatment Of Miscarriage 1st","code_information":[{"code":"2202858","type":"CDM"},{"code":"360","type":"RC"},{"code":"59821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Closure Of Split Wound 1st","code_information":[{"code":"2202860","type":"CDM"},{"code":"360","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Under Inj Procedure On The Spine 1st","code_information":[{"code":"2202878","type":"CDM"},{"code":"360","type":"RC"},{"code":"62328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Dental Surgery Procedure 1st","code_information":[{"code":"2202905","type":"CDM"},{"code":"360","type":"RC"},{"code":"41899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Procedure Nervous System 1st","code_information":[{"code":"2202925","type":"CDM"},{"code":"360","type":"RC"},{"code":"64999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Skin Tissue Procedure 1st","code_information":[{"code":"2202933","type":"CDM"},{"code":"360","type":"RC"},{"code":"17999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Egd Us Fine Needle Bx/aspir 1st","code_information":[{"code":"2202950","type":"CDM"},{"code":"360","type":"RC"},{"code":"43238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Remove Ventilating Tube 1st","code_information":[{"code":"2202963","type":"CDM"},{"code":"360","type":"RC"},{"code":"69424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Or Level 1 1st 15min","code_information":[{"code":"2202988","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202988","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9861,"maximum":9861,"gross_charge":12326,"discounted_cash":12326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9861}]}]},{"description":"Mr Lumbar Spine Wwo","code_information":[{"code":"5300040","type":"CDM"},{"code":"614","type":"RC"},{"code":"72158","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":9763,"maximum":9763,"gross_charge":12204,"discounted_cash":12204,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9763},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9763},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9763}]}]},{"description":"Inf Agent Det Chlamydia Trachomatis","code_information":[{"code":"4000224","type":"CDM"},{"code":"300","type":"RC"},{"code":"87492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9719,"maximum":9719,"gross_charge":12149,"discounted_cash":12149,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9719}]}]},{"description":"S&n Bone Anchors","code_information":[{"code":"2800788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9708,"maximum":9708,"gross_charge":12135,"discounted_cash":12135,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9708}]}]},{"description":"S&n Tendon Anchor","code_information":[{"code":"2800789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9708,"maximum":9708,"gross_charge":12135,"discounted_cash":12135,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9708}]}]},{"description":"Transcath Ther Embolization Any Method","code_information":[{"code":"5000173","type":"CDM"},{"code":"320","type":"RC"},{"code":"75894","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":9698,"maximum":9698,"gross_charge":12123,"discounted_cash":12123,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9698}]}]},{"description":"Depuy Biolox Delta Ceramic Femoral Head","code_information":[{"code":"2800169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9524,"maximum":9524,"gross_charge":11905,"discounted_cash":11905,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9524}]}]},{"description":"X Spine 6.5x40mm Pedicle Screw","code_information":[{"code":"2800708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9523,"maximum":9523,"gross_charge":11904,"discounted_cash":11904,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9523},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9523},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9523}]}]},{"description":"X-spine 6.5x35mm Pedicle Screw","code_information":[{"code":"2800711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9523,"maximum":9523,"gross_charge":11904,"discounted_cash":11904,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9523},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9523},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9523}]}]},{"description":"CT scan of abdomen and pelvis with contrast","code_information":[{"code":"5200005","type":"CDM"},{"code":"350","type":"RC"},{"code":"74177","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":9462,"maximum":9462,"gross_charge":11827,"discounted_cash":11827,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9462},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9462},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9462}]}]},{"description":"Cysto/uretero W/lithotripsy","code_information":[{"code":"2200719","type":"CDM"},{"code":"790","type":"RC"},{"code":"52356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":9451,"gross_charge":11814,"discounted_cash":11814,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9451},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9451},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9451},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2200}]}]},{"description":"Acumed 3hole R Olecrenon Plate","code_information":[{"code":"2800796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9440,"maximum":9440,"gross_charge":11800,"discounted_cash":11800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9440}]}]},{"description":"Depuy Synthes Femoral 53m75mm M/l Lar","code_information":[{"code":"2800196","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9402,"maximum":9402,"gross_charge":11752,"discounted_cash":11752,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9402}]}]},{"description":"Femoral 44","code_information":[{"code":"2800766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9400,"maximum":9400,"gross_charge":11750,"discounted_cash":11750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9400}]}]},{"description":"Jrf Versa Graft Diameter 4.0-5.0mm","code_information":[{"code":"2800254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9300,"maximum":9300,"gross_charge":11625,"discounted_cash":11625,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9300}]}]},{"description":"Speedgraft Pre-sutured Double Strand","code_information":[{"code":"2800368","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9300,"maximum":9300,"gross_charge":11625,"discounted_cash":11625,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9300}]}]},{"description":"Zavation 14mm Single Level Plate","code_information":[{"code":"2800713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9280,"maximum":9280,"gross_charge":11600,"discounted_cash":11600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9280}]}]},{"description":"Zavation Cervical Plate 18mm","code_information":[{"code":"2800723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9280,"maximum":9280,"gross_charge":11600,"discounted_cash":11600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9280}]}]},{"description":"Stryker Easyclip 20-20-20","code_information":[{"code":"2800490","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9264,"maximum":9264,"gross_charge":11580,"discounted_cash":11580,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9264}]}]},{"description":"New Or Level 6 Addl 15 Mins","code_information":[{"code":"12202993","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202993","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9215,"maximum":9215,"gross_charge":11519,"discounted_cash":11519,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9215},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9215},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9215}]}]},{"description":"Femoral Stim","code_information":[{"code":"2811736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9200,"maximum":9200,"gross_charge":11500,"discounted_cash":11500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9200}]}]},{"description":"Acumed Right Clavicle Plate","code_information":[{"code":"2800810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9128,"maximum":9128,"gross_charge":11410,"discounted_cash":11410,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9128}]}]},{"description":"Veno Extremity Unilateral","code_information":[{"code":"5000204","type":"CDM"},{"code":"320","type":"RC"},{"code":"75820","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":9026,"maximum":9026,"gross_charge":11282,"discounted_cash":11282,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9026},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9026},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9026}]}]},{"description":"Life Spine Si Tri Fin Screw 12x45mm","code_information":[{"code":"2800276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9000,"maximum":9000,"gross_charge":11250,"discounted_cash":11250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9000}]}]},{"description":"Life Spine Si Tri Fin Screw 12x55mm","code_information":[{"code":"2800277","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9000,"maximum":9000,"gross_charge":11250,"discounted_cash":11250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9000}]}]},{"description":"Acumed Narrow Left Distal Radius Plate","code_information":[{"code":"2800052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8936,"maximum":8936,"gross_charge":11170,"discounted_cash":11170,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8936}]}]},{"description":"Delta Modular Humeral Stem Cmentless","code_information":[{"code":"2800157","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8856,"maximum":8856,"gross_charge":11070,"discounted_cash":11070,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8856},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8856},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8856}]}]},{"description":"Depuy Polyethylene Acetabular Liner","code_information":[{"code":"2800172","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8856,"maximum":8856,"gross_charge":11070,"discounted_cash":11070,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8856},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8856},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8856}]}]},{"description":"Acumed 5hole Olecranon Plate Left","code_information":[{"code":"2800043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8820,"maximum":8820,"gross_charge":11025,"discounted_cash":11025,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8820},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8820},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8820}]}]},{"description":"Allosource Achilles Tendon Graft","code_information":[{"code":"2800060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8800,"maximum":8800,"gross_charge":11000,"discounted_cash":11000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8800}]}]},{"description":"Medtronic Controller Pain Intellis Paper","code_information":[{"code":"2800289","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8800,"maximum":8800,"gross_charge":11000,"discounted_cash":11000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8800}]}]},{"description":"Phasix St Mesh 11cm","code_information":[{"code":"2800349","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8730,"maximum":8730,"gross_charge":10912,"discounted_cash":10912,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8730}]}]},{"description":"Arthrex Suture Anchor 8x19.5mm","code_information":[{"code":"2800093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8700,"maximum":8700,"gross_charge":10875,"discounted_cash":10875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8700}]}]},{"description":"Medtronic 75mm Cervical Plate","code_information":[{"code":"2800285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8688,"maximum":8688,"gross_charge":10860,"discounted_cash":10860,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8688},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8688},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8688}]}]},{"description":"Medtronic 80mm Plate","code_information":[{"code":"2800286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8688,"maximum":8688,"gross_charge":10860,"discounted_cash":10860,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8688},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8688},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8688}]}]},{"description":"Medtronic Cervical Plate 77.5","code_information":[{"code":"2800288","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8688,"maximum":8688,"gross_charge":10860,"discounted_cash":10860,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8688},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8688},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8688}]}]},{"description":"Nevro  Blue Lead Kit","code_information":[{"code":"2800328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8680,"maximum":8680,"gross_charge":10850,"discounted_cash":10850,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8680},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8680},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8680}]}]},{"description":"Zavation 6mm Cervical Peek Cage","code_information":[{"code":"2800721","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8640,"maximum":8640,"gross_charge":10800,"discounted_cash":10800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8640}]}]},{"description":"Zavation Cif 12/14 09 Cage","code_information":[{"code":"2800724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8640,"maximum":8640,"gross_charge":10800,"discounted_cash":10800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8640}]}]},{"description":"Zavation Cif 12x14 Peek Cage","code_information":[{"code":"2800725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8640,"maximum":8640,"gross_charge":10800,"discounted_cash":10800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8640}]}]},{"description":"Zaviation Cif 12/14 Odig 07 Cage","code_information":[{"code":"2800733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8640,"maximum":8640,"gross_charge":10800,"discounted_cash":10800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8640}]}]},{"description":"Trial Lead Kit 70b","code_information":[{"code":"2800680","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8600,"maximum":8600,"gross_charge":10750,"discounted_cash":10750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8600}]}]},{"description":"Nevro Blue Perc Lead Kit","code_information":[{"code":"2800329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8588,"maximum":8588,"gross_charge":10735,"discounted_cash":10735,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8588}]}]},{"description":"Ct Abdomen Pelvis Without Iv","code_information":[{"code":"5200006","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8558,"maximum":8558,"gross_charge":10697,"discounted_cash":10697,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8558}]}]},{"description":"Acumed 6 Hole Clavicle Plate","code_information":[{"code":"2800044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8528,"maximum":8528,"gross_charge":10660,"discounted_cash":10660,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8528}]}]},{"description":"Acumed 6 Hole Clavicle Plate Acumed (Rt)","code_information":[{"code":"2800045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8528,"maximum":8528,"gross_charge":10660,"discounted_cash":10660,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8528}]}]},{"description":"Stryker Allowrap Ds Wet 2x4 Per Sq Cm","code_information":[{"code":"2800449","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8512,"maximum":8512,"gross_charge":10640,"discounted_cash":10640,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8512},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8512},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8512}]}]},{"description":"Stryker Narrow Lock Plate .0 L34mm 6hole","code_information":[{"code":"2800537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8512,"maximum":8512,"gross_charge":10640,"discounted_cash":10640,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8512},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8512},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8512}]}]},{"description":"Obstetrical Care","code_information":[{"code":"1000285","type":"CDM"},{"code":"450","type":"RC"},{"code":"59409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":8307,"gross_charge":10384,"discounted_cash":10384,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8307},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8307},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8307}]}]},{"description":"Mr Chest Wwo","code_information":[{"code":"5300023","type":"CDM"},{"code":"614","type":"RC"},{"code":"71552","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8306,"maximum":8306,"gross_charge":10383,"discounted_cash":10383,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8306}]}]},{"description":"Biocomposite Pucshlock","code_information":[{"code":"2800129","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8300,"maximum":8300,"gross_charge":10375,"discounted_cash":10375,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8300}]}]},{"description":"Ct Angio Abd/pel With And Without Iv","code_information":[{"code":"5000046","type":"CDM"},{"code":"352","type":"RC"},{"code":"74174","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8295,"maximum":8295,"gross_charge":10369,"discounted_cash":10369,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8295}]}]},{"description":"Ct Angiography Abd&pelvis W/wo Contrast","code_information":[{"code":"8400061","type":"CDM"},{"code":"352","type":"RC"},{"code":"74174","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8295,"maximum":8295,"gross_charge":10369,"discounted_cash":10369,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8295}]}]},{"description":"Insert Indwell Tunnel Pleural Cath W/cuf","code_information":[{"code":"1000173","type":"CDM"},{"code":"450","type":"RC"},{"code":"32550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":8286,"gross_charge":10357,"discounted_cash":10357,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8286}]}]},{"description":"Depuy Synthes 3.5mm Lcp Superior Clavicl","code_information":[{"code":"2800189","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8220,"maximum":8220,"gross_charge":10275,"discounted_cash":10275,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8220}]}]},{"description":"Mr Joint Low Extr Wwo Rt","code_information":[{"code":"5300069","type":"CDM"},{"code":"614","type":"RC"},{"code":"73723","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":8213,"maximum":8213,"gross_charge":10266,"discounted_cash":10266,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8213}]}]},{"description":"Mr Joint Upper Extr Wwo Rt","code_information":[{"code":"5300072","type":"CDM"},{"code":"614","type":"RC"},{"code":"73223","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":8213,"maximum":8213,"gross_charge":10266,"discounted_cash":10266,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8213}]}]},{"description":"Mr Non-joint Low Extr Wwo Rt","code_information":[{"code":"5300075","type":"CDM"},{"code":"614","type":"RC"},{"code":"73720","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":8213,"maximum":8213,"gross_charge":10266,"discounted_cash":10266,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8213}]}]},{"description":"Mr Non-joint Upper Extr Wwo Rt","code_information":[{"code":"5300078","type":"CDM"},{"code":"614","type":"RC"},{"code":"73220","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":8213,"maximum":8213,"gross_charge":10266,"discounted_cash":10266,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8213}]}]},{"description":"Cardiac Mri For Morph W/dye","code_information":[{"code":"5300001","type":"CDM"},{"code":"360","type":"RC"},{"code":"75561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Abd Wwo","code_information":[{"code":"5300007","type":"CDM"},{"code":"614","type":"RC"},{"code":"74183","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Joint Low Extr Wwo Lt","code_information":[{"code":"5300010","type":"CDM"},{"code":"614","type":"RC"},{"code":"73723","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Joint Upper Extr Wwo Lt","code_information":[{"code":"5300013","type":"CDM"},{"code":"614","type":"RC"},{"code":"73223","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mri Open Intracranial Proc W/wo Dye","code_information":[{"code":"5300017","type":"CDM"},{"code":"614","type":"RC"},{"code":"70559","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"MRI Scan","code_information":[{"code":"5300020","type":"CDM"},{"code":"610","type":"RC"},{"code":"70553","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Non-joint Low Extr Wwo Lt","code_information":[{"code":"5300026","type":"CDM"},{"code":"614","type":"RC"},{"code":"73720","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Orbs/face/neck Wwo","code_information":[{"code":"5300029","type":"CDM"},{"code":"614","type":"RC"},{"code":"70543","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Pelvis Wwo","code_information":[{"code":"5300032","type":"CDM"},{"code":"359","type":"RC"},{"code":"72197","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Cervical Spine Wwo","code_information":[{"code":"5300039","type":"CDM"},{"code":"614","type":"RC"},{"code":"72156","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mri Thoracic Spine Wwo","code_information":[{"code":"5300041","type":"CDM"},{"code":"614","type":"RC"},{"code":"72157","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Non-joint Upper Extr Wwo Lt","code_information":[{"code":"5300045","type":"CDM"},{"code":"614","type":"RC"},{"code":"73220","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Angiograph Head W/wo Dye","code_information":[{"code":"5300050","type":"CDM"},{"code":"614","type":"RC"},{"code":"70546","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Mr Angiograph Neck W/wo Dye","code_information":[{"code":"5300054","type":"CDM"},{"code":"614","type":"RC"},{"code":"70549","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":8212,"maximum":8212,"gross_charge":10265,"discounted_cash":10265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8212}]}]},{"description":"Medtronic 52.5mm Plate","code_information":[{"code":"2800283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8124,"maximum":8124,"gross_charge":10155,"discounted_cash":10155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8124}]}]},{"description":"Medtronic 60mm Plate","code_information":[{"code":"2800284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8124,"maximum":8124,"gross_charge":10155,"discounted_cash":10155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8124}]}]},{"description":"Medtronic Plate 55mm.","code_information":[{"code":"2800298","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8124,"maximum":8124,"gross_charge":10155,"discounted_cash":10155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8124}]}]},{"description":"Medtronic Plate 57.5","code_information":[{"code":"2800299","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8124,"maximum":8124,"gross_charge":10155,"discounted_cash":10155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8124}]}]},{"description":"Medtronic Plate 62.5","code_information":[{"code":"2800300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8124,"maximum":8124,"gross_charge":10155,"discounted_cash":10155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8124}]}]},{"description":"Metronic 65mm Plate","code_information":[{"code":"2800306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8124,"maximum":8124,"gross_charge":10155,"discounted_cash":10155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8124}]}]},{"description":"Wright 1-hole Universal Plate","code_information":[{"code":"2800694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8107,"maximum":8107,"gross_charge":10134,"discounted_cash":10134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8107}]}]},{"description":"Intraatrial Pacing","code_information":[{"code":"4200013","type":"CDM"},{"code":"730","type":"RC"},{"code":"93610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":8010,"gross_charge":10013,"discounted_cash":10013,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8010},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Intra-atrial Pacing","code_information":[{"code":"8400372","type":"CDM"},{"code":"450","type":"RC"},{"code":"93610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":8010,"gross_charge":10013,"discounted_cash":10013,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8010},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Evolution Medical 16x13xdegree 0x7mm","code_information":[{"code":"2800209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8000,"maximum":8000,"gross_charge":10000,"discounted_cash":10000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8000}]}]},{"description":"Providence Cavux Carvical Care-x","code_information":[{"code":"2800364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8000,"maximum":8000,"gross_charge":10000,"discounted_cash":10000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8000}]}]},{"description":"Vertefix Hv Kyphoplasty","code_information":[{"code":"2800692","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8000,"maximum":8000,"gross_charge":10000,"discounted_cash":10000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8000}]}]},{"description":"Insertion Of Tunneled Intraperitoneal Ca","code_information":[{"code":"2210144","type":"CDM"},{"code":"360","type":"RC"},{"code":"49421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":7911,"gross_charge":9889,"discounted_cash":9889,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7911},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7911},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7911}]}]},{"description":"Treat Lower Jaw Fracture","code_information":[{"code":"1000040","type":"CDM"},{"code":"450","type":"RC"},{"code":"21451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":7910,"gross_charge":9888,"discounted_cash":9888,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7910},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7910},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7910}]}]},{"description":"Stryker Anchor Lapidus Plating","code_information":[{"code":"2800450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7853,"maximum":7853,"gross_charge":9816,"discounted_cash":9816,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7853},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7853},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7853}]}]},{"description":"Tl Amedica Valeo Ii 6degree 10x27x9mm","code_information":[{"code":"2800672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7800,"maximum":7800,"gross_charge":9750,"discounted_cash":9750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7800}]}]},{"description":"Psu Bx Breast With Pellet Placement","code_information":[{"code":"600004","type":"CDM"},{"code":"509","type":"RC"},{"code":"19081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":7774,"gross_charge":9717,"discounted_cash":9717,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7774},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7774},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7774}]}]},{"description":"Treatment Of Thigh Fracture","code_information":[{"code":"1000028","type":"CDM"},{"code":"450","type":"RC"},{"code":"27502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":7773,"gross_charge":9716,"discounted_cash":9716,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7773},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7773},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7773}]}]},{"description":"Valeo Ll 12mm 18x55","code_information":[{"code":"2800688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7750,"maximum":7750,"gross_charge":9688,"discounted_cash":9688,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7750},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7750},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7750}]}]},{"description":"Magnetic Resonance Guidance","code_information":[{"code":"5300059","type":"CDM"},{"code":"614","type":"RC"},{"code":"77022","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7722,"maximum":7722,"gross_charge":9652,"discounted_cash":9652,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7722},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7722},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7722}]}]},{"description":"Tibial 45","code_information":[{"code":"2800767","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7694,"maximum":7694,"gross_charge":9617,"discounted_cash":9617,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7694}]}]},{"description":"Stryker 2.5cc Bio Viable Bone Matrix","code_information":[{"code":"2800431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7650,"maximum":7650,"gross_charge":9563,"discounted_cash":9563,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7650},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7650},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7650}]}]},{"description":"Ceramic Insert Neutral","code_information":[{"code":"2812736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7600,"maximum":7600,"gross_charge":9500,"discounted_cash":9500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7600}]}]},{"description":"Depuy Volar Distal Plate","code_information":[{"code":"2800778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7572,"maximum":7572,"gross_charge":9465,"discounted_cash":9465,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7572},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7572},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7572}]}]},{"description":"Mri W/o Fol W/cont Brst Unilat","code_information":[{"code":"5300061","type":"CDM"},{"code":"614","type":"RC"},{"code":"C8905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7462,"maximum":7462,"gross_charge":9328,"discounted_cash":9328,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7462},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7462},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7462}]}]},{"description":"Mri Breast C-+ W/cad Uni","code_information":[{"code":"5400002","type":"CDM"},{"code":"614","type":"RC"},{"code":"77048","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7462,"maximum":7462,"gross_charge":9328,"discounted_cash":9328,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7462},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7462},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7462}]}]},{"description":"Right Heart Catheterization Including Me","code_information":[{"code":"22100008","type":"CDM"},{"code":"360","type":"RC"},{"code":"93451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":7451,"gross_charge":9314,"discounted_cash":9314,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7451},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7451},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7451}]}]},{"description":"Catheter Placement In Coronary Artery(s)","code_information":[{"code":"22100012","type":"CDM"},{"code":"360","type":"RC"},{"code":"93460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":7451,"gross_charge":9314,"discounted_cash":9314,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7451},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7451},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7451}]}]},{"description":"Depuy Synthes 2.7mm Va Locking Screw","code_information":[{"code":"2800185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7430,"maximum":7430,"gross_charge":9288,"discounted_cash":9288,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7430}]}]},{"description":"Ifuse Torq Implant 7.0mm X50mm","code_information":[{"code":"28000138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7430,"maximum":7430,"gross_charge":9288,"discounted_cash":9288,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7430}]}]},{"description":"Ifuse Torq Implant 11.5mm X50mm","code_information":[{"code":"28000165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7430,"maximum":7430,"gross_charge":9288,"discounted_cash":9288,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7430}]}]},{"description":"Ifuse Torq Implant 11.5mm X45mm","code_information":[{"code":"28000185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7430,"maximum":7430,"gross_charge":9288,"discounted_cash":9288,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7430}]}]},{"description":"Synthes 2.4mm Va-lcp Radius Plate 6h Hd","code_information":[{"code":"2800577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7360,"maximum":7360,"gross_charge":9200,"discounted_cash":9200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7360}]}]},{"description":"Mr Non-joint Upper Extr W Lt","code_information":[{"code":"5300043","type":"CDM"},{"code":"614","type":"RC"},{"code":"73219","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":7350,"maximum":7350,"gross_charge":9188,"discounted_cash":9188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7350}]}]},{"description":"Mr Non-joint Upper Extr W Rt","code_information":[{"code":"5300077","type":"CDM"},{"code":"614","type":"RC"},{"code":"73219","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":7350,"maximum":7350,"gross_charge":9188,"discounted_cash":9188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7350}]}]},{"description":"Introduction Of Needle(s) And/or Cathete","code_information":[{"code":"22000127","type":"CDM"},{"code":"360","type":"RC"},{"code":"36901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":7325,"gross_charge":9156,"discounted_cash":9156,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7325},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7325},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7325}]}]},{"description":"Replacement, Complete, Of A Tunneled Cen","code_information":[{"code":"2210145","type":"CDM"},{"code":"360","type":"RC"},{"code":"36581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":7289,"gross_charge":9111,"discounted_cash":9111,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7289},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7289},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7289}]}]},{"description":"Mr Abd W","code_information":[{"code":"5300005","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Joint Low Extr W Lt","code_information":[{"code":"5300008","type":"CDM"},{"code":"614","type":"RC"},{"code":"73722","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Joint Upper Extr W Lt","code_information":[{"code":"5300011","type":"CDM"},{"code":"614","type":"RC"},{"code":"73222","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mri Open Intracranial Proc W/dye","code_information":[{"code":"5300015","type":"CDM"},{"code":"614","type":"RC"},{"code":"70558","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Brain W","code_information":[{"code":"5300018","type":"CDM"},{"code":"614","type":"RC"},{"code":"70552","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Chest W","code_information":[{"code":"5300021","type":"CDM"},{"code":"614","type":"RC"},{"code":"71551","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Non-joint Low Extr W Lt","code_information":[{"code":"5300024","type":"CDM"},{"code":"614","type":"RC"},{"code":"73719","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Orbs/face/neck W","code_information":[{"code":"5300027","type":"CDM"},{"code":"614","type":"RC"},{"code":"70542","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Pelvis W","code_information":[{"code":"5300030","type":"CDM"},{"code":"359","type":"RC"},{"code":"72196","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Cervical Spine W","code_information":[{"code":"5300033","type":"CDM"},{"code":"359","type":"RC"},{"code":"72142","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Lumbar Spine W","code_information":[{"code":"5300035","type":"CDM"},{"code":"614","type":"RC"},{"code":"72149","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mri Thoracic Spine W","code_information":[{"code":"5300037","type":"CDM"},{"code":"359","type":"RC"},{"code":"72147","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Angiography Head W/dye","code_information":[{"code":"5300048","type":"CDM"},{"code":"614","type":"RC"},{"code":"70545","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Angiography Neck W/dye","code_information":[{"code":"5300052","type":"CDM"},{"code":"614","type":"RC"},{"code":"70548","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Joint Low Extr W Rt","code_information":[{"code":"5300068","type":"CDM"},{"code":"614","type":"RC"},{"code":"73722","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Joint Upper Extr W Rt","code_information":[{"code":"5300071","type":"CDM"},{"code":"614","type":"RC"},{"code":"73222","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Mr Non-joint Low Extr W Rt","code_information":[{"code":"5300074","type":"CDM"},{"code":"614","type":"RC"},{"code":"73719","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":7260,"maximum":7260,"gross_charge":9075,"discounted_cash":9075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7260}]}]},{"description":"Advantage Fit Urethral Sling System","code_information":[{"code":"2800057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7212,"maximum":7212,"gross_charge":9015,"discounted_cash":9015,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7212}]}]},{"description":"Evolution Medical 3 Level 51mm Cervical","code_information":[{"code":"2800210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7200,"maximum":7200,"gross_charge":9000,"discounted_cash":9000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7200}]}]},{"description":"Echo Exam Of Fetal Heart","code_information":[{"code":"5000072","type":"CDM"},{"code":"483","type":"RC"},{"code":"76825","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":950,"maximum":7186,"gross_charge":8983,"discounted_cash":8983,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Combined Right And Left Heart Catheteriz","code_information":[{"code":"22100004","type":"CDM"},{"code":"360","type":"RC"},{"code":"93453","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":7102,"gross_charge":8878,"discounted_cash":8878,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7102}]}]},{"description":"Catheter Placement In Coronary Artery(s)","code_information":[{"code":"22100002","type":"CDM"},{"code":"360","type":"RC"},{"code":"93458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":7100,"gross_charge":8875,"discounted_cash":8875,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7100}]}]},{"description":"Arthrex 5.5 Cork Screw Anchor","code_information":[{"code":"2800071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7100,"maximum":7100,"gross_charge":8875,"discounted_cash":8875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7100}]}]},{"description":"New Or Level 5 Addl 15 Mins","code_information":[{"code":"12202991","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202991","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7090,"maximum":7090,"gross_charge":8862,"discounted_cash":8862,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7090},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7090},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7090}]}]},{"description":"Delta Xtend Cementless Metaglene","code_information":[{"code":"2800158","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7070,"maximum":7070,"gross_charge":8837,"discounted_cash":8837,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7070},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7070},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7070}]}]},{"description":"Mr Cervical Spine Wo","code_information":[{"code":"5300034","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":7029,"maximum":7029,"gross_charge":8786,"discounted_cash":8786,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7029},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7029},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7029}]}]},{"description":"Acumed Distal Ulna Long Plate","code_information":[{"code":"2800048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6976,"maximum":6976,"gross_charge":8720,"discounted_cash":8720,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6976},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6976},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6976}]}]},{"description":"Acumed 3hole R Distal Ulna Plate","code_information":[{"code":"2800802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6976,"maximum":6976,"gross_charge":8720,"discounted_cash":8720,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6976},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6976},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6976}]}]},{"description":"Medtronic 45mm Plate","code_information":[{"code":"2800281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6975,"maximum":6975,"gross_charge":8719,"discounted_cash":8719,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6975}]}]},{"description":"Medtronic 47.5mm Plate","code_information":[{"code":"2800282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6975,"maximum":6975,"gross_charge":8719,"discounted_cash":8719,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6975}]}]},{"description":"Medtronic Plate 40mm","code_information":[{"code":"2800296","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6975,"maximum":6975,"gross_charge":8719,"discounted_cash":8719,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6975}]}]},{"description":"Medtronic Plate 42.5mm","code_information":[{"code":"2800297","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6975,"maximum":6975,"gross_charge":8719,"discounted_cash":8719,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6975}]}]},{"description":"Arthrex Achilles Speedbridge 4.75x19.1mm","code_information":[{"code":"2800074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6960,"maximum":6960,"gross_charge":8700,"discounted_cash":8700,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6960},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6960},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6960}]}]},{"description":"Arthrex Speed Bridge Implant System 4.75","code_information":[{"code":"2800090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6960,"maximum":6960,"gross_charge":8700,"discounted_cash":8700,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6960},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6960},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6960}]}]},{"description":"Transcatheter Therapy Infusion","code_information":[{"code":"5000174","type":"CDM"},{"code":"320","type":"RC"},{"code":"75896","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":6944,"maximum":6944,"gross_charge":8680,"discounted_cash":8680,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6944},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6944},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6944}]}]},{"description":"Respiratory Pathogen Panel","code_information":[{"code":"4000241","type":"CDM"},{"code":"300","type":"RC"},{"code":"87633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6861,"maximum":6861,"gross_charge":8576,"discounted_cash":8576,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6861}]}]},{"description":"Wright Lapidus Plate.","code_information":[{"code":"2800703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6858,"maximum":6858,"gross_charge":8572,"discounted_cash":8572,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6858},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6858},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6858}]}]},{"description":"Arthrex 3mm Suture Anchor","code_information":[{"code":"2800068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6800,"maximum":6800,"gross_charge":8500,"discounted_cash":8500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6800}]}]},{"description":"Medtronic Recharger","code_information":[{"code":"2800301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6800,"maximum":6800,"gross_charge":8500,"discounted_cash":8500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6800}]}]},{"description":"Stryker Easyclip 18-19-17","code_information":[{"code":"2800489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6792,"maximum":6792,"gross_charge":8490,"discounted_cash":8490,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6792},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6792},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6792}]}]},{"description":"Colposcopy Of The Cervix Including Upper","code_information":[{"code":"22100005","type":"CDM"},{"code":"360","type":"RC"},{"code":"57460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":6786,"gross_charge":8482,"discounted_cash":8482,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6786}]}]},{"description":"Sigmoidoscopy W/fb Removal","code_information":[{"code":"2202659","type":"CDM"},{"code":"750","type":"RC"},{"code":"45332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":6730,"gross_charge":8413,"discounted_cash":8413,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6730}]}]},{"description":"Synthes 2.4mm Va Lcp 2-column Volar Dist","code_information":[{"code":"2800576","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6728,"maximum":6728,"gross_charge":8410,"discounted_cash":8410,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6728},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6728},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6728}]}]},{"description":"MRI scan of lower spinal canal","code_information":[{"code":"5300036","type":"CDM"},{"code":"610","type":"RC"},{"code":"72148","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":6708,"maximum":6708,"gross_charge":8385,"discounted_cash":8385,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6708}]}]},{"description":"Stryker Slim Y Plate 3 Shaft Holes","code_information":[{"code":"2800546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6704,"maximum":6704,"gross_charge":8380,"discounted_cash":8380,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6704},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6704},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6704}]}]},{"description":"Synthes 2.4 Va Distal Radius Plate","code_information":[{"code":"2800572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6692,"maximum":6692,"gross_charge":8365,"discounted_cash":8365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6692},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6692},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6692}]}]},{"description":"Stryker Vitoss Foam Pack 2.5cc","code_information":[{"code":"2800550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6636,"maximum":6636,"gross_charge":8295,"discounted_cash":8295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6636}]}]},{"description":"Repair Hand Joint","code_information":[{"code":"1000244","type":"CDM"},{"code":"450","type":"RC"},{"code":"26540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":6622,"gross_charge":8277,"discounted_cash":8277,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6622},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6622},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6622}]}]},{"description":"Medtronic Lateral Ports Spacer","code_information":[{"code":"2800294","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6580,"maximum":6580,"gross_charge":8225,"discounted_cash":8225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6580},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6580},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6580}]}]},{"description":"B.s Obtryx Ii Halo System","code_information":[{"code":"2800118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6530,"maximum":6530,"gross_charge":8162,"discounted_cash":8162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6530},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6530},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6530}]}]},{"description":"Ct Abdomen And Pelvis Without Contrast","code_information":[{"code":"8400063","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6527,"maximum":6527,"gross_charge":8159,"discounted_cash":8159,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6527}]}]},{"description":"Acumed Long Left Distal Ulna Plate","code_information":[{"code":"2800051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6520,"maximum":6520,"gross_charge":8150,"discounted_cash":8150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6520},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6520},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6520}]}]},{"description":"Integra Silicone Mcp Size 20","code_information":[{"code":"2800236","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6516,"maximum":6516,"gross_charge":8145,"discounted_cash":8145,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6516}]}]},{"description":"Arthrex 3x14.5 Small Joint","code_information":[{"code":"2800070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6500,"maximum":6500,"gross_charge":8125,"discounted_cash":8125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6500}]}]},{"description":"Ctl Amedica Valeo Ii Pl Cage 9mm 9x26","code_information":[{"code":"2800150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6500,"maximum":6500,"gross_charge":8125,"discounted_cash":8125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6500}]}]},{"description":"Medtronic Plate 25mm.","code_information":[{"code":"2800295","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6486,"maximum":6486,"gross_charge":8108,"discounted_cash":8108,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6486}]}]},{"description":"Jones Fracture Plate Sm Right","code_information":[{"code":"2800252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6464,"maximum":6464,"gross_charge":8080,"discounted_cash":8080,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6464},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6464},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6464}]}]},{"description":"Mr Pelvis Wo","code_information":[{"code":"5300031","type":"CDM"},{"code":"614","type":"RC"},{"code":"72195","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":6464,"maximum":6464,"gross_charge":8080,"discounted_cash":8080,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6464},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6464},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6464}]}]},{"description":"Bard Ventralight Mesh 6  X 8","code_information":[{"code":"2800128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6446,"maximum":6446,"gross_charge":8058,"discounted_cash":8058,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6446}]}]},{"description":"Ct Cervical Spine Wo","code_information":[{"code":"5200013","type":"CDM"},{"code":"359","type":"RC"},{"code":"72125","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Life Spine 6.5 Avatr Screw 55mm","code_information":[{"code":"2800263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Life Spine Avar 6.5 X 50","code_information":[{"code":"2800264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Life Spine Avatar 6.5 45","code_information":[{"code":"2800265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Life Spine Avatar 7.5 45mm","code_information":[{"code":"2800266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Spinal Elements 29mm Cervical Plate","code_information":[{"code":"2800382","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Spinal Elements 48mm 3 Level Plate","code_information":[{"code":"2800384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Spinal Elements 51 31v1 Plate","code_information":[{"code":"2800386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Spinal Elements 54mm 31v1 Plate","code_information":[{"code":"2800387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Spinal Elements 72mm Plate","code_information":[{"code":"2800397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Spinal Evolution 34mm Plate","code_information":[{"code":"2800400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Zavation 32mm Plate","code_information":[{"code":"2800717","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6400,"maximum":6400,"gross_charge":8000,"discounted_cash":8000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6400}]}]},{"description":"Medtronic 42.5mm Plate","code_information":[{"code":"2800280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6362,"maximum":6362,"gross_charge":7952,"discounted_cash":7952,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6362},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6362},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6362}]}]},{"description":"Exc Benign Lsn S/n/h/f/g 3.1-4.0 Cm","code_information":[{"code":"1000129","type":"CDM"},{"code":"450","type":"RC"},{"code":"11424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":6353,"gross_charge":7941,"discounted_cash":7941,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6353},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6353},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6353}]}]},{"description":"Transcatheter Biopsy Rad Sup&int","code_information":[{"code":"5000172","type":"CDM"},{"code":"320","type":"RC"},{"code":"75970","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":6275,"maximum":6275,"gross_charge":7844,"discounted_cash":7844,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6275}]}]},{"description":"Removal Of Foreign Body","code_information":[{"code":"1000202","type":"CDM"},{"code":"450","type":"RC"},{"code":"27372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":6250,"gross_charge":7813,"discounted_cash":7813,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6250}]}]},{"description":"Aorto/serialography Abd Rad Sup&int","code_information":[{"code":"5000019","type":"CDM"},{"code":"329","type":"RC"},{"code":"75625","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":6250,"maximum":6250,"gross_charge":7812,"discounted_cash":7812,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6250}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"1000068","type":"CDM"},{"code":"450","type":"RC"},{"code":"24535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":6246,"gross_charge":7808,"discounted_cash":7808,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6246}]}]},{"description":"Biopsy, Abdominal Or Retroperitoneal Mas","code_information":[{"code":"2820357","type":"CDM"},{"code":"360","type":"RC"},{"code":"49180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":6179,"gross_charge":7724,"discounted_cash":7724,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6179},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6179},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6179}]}]},{"description":"Mr Angio Upr Extr W/o&w/dye","code_information":[{"code":"5300057","type":"CDM"},{"code":"614","type":"RC"},{"code":"73225","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":6167,"maximum":6167,"gross_charge":7709,"discounted_cash":7709,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6167},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6167},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6167}]}]},{"description":"Arthrex Internalbrace Ligament","code_information":[{"code":"2800088","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6144,"maximum":6144,"gross_charge":7680,"discounted_cash":7680,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6144}]}]},{"description":"Egd Guide Wire Insertion","code_information":[{"code":"2202945","type":"CDM"},{"code":"750","type":"RC"},{"code":"43248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":6117,"gross_charge":7646,"discounted_cash":7646,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6117},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6117},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6117}]}]},{"description":"Closed Tx Knee Dislocation W/o Anes","code_information":[{"code":"1000041","type":"CDM"},{"code":"450","type":"RC"},{"code":"21440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":6086,"gross_charge":7607,"discounted_cash":7607,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6086},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6086},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6086}]}]},{"description":"Genspine Polyaxial Screw 6.5 X 40","code_information":[{"code":"2800218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6080,"maximum":6080,"gross_charge":7600,"discounted_cash":7600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6080}]}]},{"description":"Zavation Polyaxial Screw 6.5 X 35","code_information":[{"code":"2800727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6080,"maximum":6080,"gross_charge":7600,"discounted_cash":7600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6080}]}]},{"description":"Zavation Polyaxial Screw 6.5 X 45","code_information":[{"code":"2800728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6080,"maximum":6080,"gross_charge":7600,"discounted_cash":7600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6080}]}]},{"description":"Zaviation Polyaxial Screw 7.5x35","code_information":[{"code":"2800734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6080,"maximum":6080,"gross_charge":7600,"discounted_cash":7600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6080}]}]},{"description":"Mri Brain By Phys/psych","code_information":[{"code":"5300063","type":"CDM"},{"code":"614","type":"RC"},{"code":"70555","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":6039,"maximum":6039,"gross_charge":7549,"discounted_cash":7549,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6039},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6039},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6039}]}]},{"description":"Implant Medium Cannulated","code_information":[{"code":"2800230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6014,"maximum":6014,"gross_charge":7517,"discounted_cash":7517,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6014}]}]},{"description":"10cc Dbm","code_information":[{"code":"2800002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6000,"maximum":6000,"gross_charge":7500,"discounted_cash":7500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6000}]}]},{"description":"Corus Spinal System-x","code_information":[{"code":"2800147","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6000,"maximum":6000,"gross_charge":7500,"discounted_cash":7500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6000}]}]},{"description":"Life Spine Osteo Link Dbm 10cc","code_information":[{"code":"2800269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6000,"maximum":6000,"gross_charge":7500,"discounted_cash":7500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6000}]}]},{"description":"Medtronic Electronic For Spinal Stimulat","code_information":[{"code":"2800290","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6000,"maximum":6000,"gross_charge":7500,"discounted_cash":7500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6000}]}]},{"description":"Stimulan Beads (L8699)","code_information":[{"code":"2800415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6000,"maximum":6000,"gross_charge":7500,"discounted_cash":7500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6000}]}]},{"description":"Catheter, Balloon Dilatation, Non-vascul","code_information":[{"code":"28000751","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6000,"maximum":6000,"gross_charge":7500,"discounted_cash":7500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6000}]}]},{"description":"Transluminal Balloon Angioplasty (Except","code_information":[{"code":"28000758","type":"CDM"},{"code":"360","type":"RC"},{"code":"37249","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":6000,"gross_charge":7500,"discounted_cash":7500,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6000}]}]},{"description":"Mr Non-joint Upper Extr Wo Lt","code_information":[{"code":"5300044","type":"CDM"},{"code":"614","type":"RC"},{"code":"73218","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":5992,"maximum":5992,"gross_charge":7490,"discounted_cash":7490,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5992},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5992},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5992}]}]},{"description":"Mr Non-joint Upper Extr Wo Rt","code_information":[{"code":"5300079","type":"CDM"},{"code":"614","type":"RC"},{"code":"73218","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":5992,"maximum":5992,"gross_charge":7490,"discounted_cash":7490,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5992},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5992},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5992}]}]},{"description":"Arthrex Distal Extremity Internal Brace","code_information":[{"code":"2800082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5980,"maximum":5980,"gross_charge":7475,"discounted_cash":7475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5980}]}]},{"description":"Arthrex Ib Kit, Bc W/cc Ft And Jumpstart","code_information":[{"code":"2800084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5980,"maximum":5980,"gross_charge":7475,"discounted_cash":7475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5980}]}]},{"description":"Arthrex Tightrope","code_information":[{"code":"2800097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5980,"maximum":5980,"gross_charge":7475,"discounted_cash":7475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5980}]}]},{"description":"Ct Lumbar Spine Wwo","code_information":[{"code":"5200024","type":"CDM"},{"code":"359","type":"RC"},{"code":"72133","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5893,"maximum":5893,"gross_charge":7366,"discounted_cash":7366,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5893},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5893},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5893}]}]},{"description":"Ct Lumbar Spine W/wo Contrast","code_information":[{"code":"8400046","type":"CDM"},{"code":"359","type":"RC"},{"code":"72133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5893,"maximum":5893,"gross_charge":7366,"discounted_cash":7366,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5893},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5893},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5893}]}]},{"description":"Ct Abdomen With And Without Iv","code_information":[{"code":"5200010","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5810,"maximum":5810,"gross_charge":7262,"discounted_cash":7262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5810},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5810},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5810}]}]},{"description":"Interspinous Process Distraction Device","code_information":[{"code":"28000298","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5802,"maximum":5802,"gross_charge":7253,"discounted_cash":7253,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5802},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5802},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5802}]}]},{"description":"Discography Cerv Or Thoracic Rad Sup&int","code_information":[{"code":"5000063","type":"CDM"},{"code":"614","type":"RC"},{"code":"72285","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5770,"maximum":5770,"gross_charge":7212,"discounted_cash":7212,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5770}]}]},{"description":"Discography Lumbar Rad Sup&int","code_information":[{"code":"5000064","type":"CDM"},{"code":"614","type":"RC"},{"code":"72295","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5770,"maximum":5770,"gross_charge":7212,"discounted_cash":7212,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5770}]}]},{"description":"Myelography Lumbosacral Rad Sup&int","code_information":[{"code":"5000116","type":"CDM"},{"code":"614","type":"RC"},{"code":"72265","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5757,"maximum":5757,"gross_charge":7196,"discounted_cash":7196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5757}]}]},{"description":"Temporomandibular Jt Arthro Rad Sup&int","code_information":[{"code":"5000163","type":"CDM"},{"code":"329","type":"RC"},{"code":"70332","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5757,"maximum":5757,"gross_charge":7196,"discounted_cash":7196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5757}]}]},{"description":"Cholangio/ Pancreatography W/ Cath","code_information":[{"code":"5000039","type":"CDM"},{"code":"329","type":"RC"},{"code":"74305","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Dacryocysto Nasolac Duct Rad Sup&int","code_information":[{"code":"5000061","type":"CDM"},{"code":"329","type":"RC"},{"code":"70170","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Hysterosalpingography Rad Sup&int","code_information":[{"code":"5000090","type":"CDM"},{"code":"329","type":"RC"},{"code":"74740","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Lymphangiography Extremity Uni Rad","code_information":[{"code":"5000103","type":"CDM"},{"code":"320","type":"RC"},{"code":"75801","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Mammary Ductogram/galactogram Mult Ducts","code_information":[{"code":"5000107","type":"CDM"},{"code":"320","type":"RC"},{"code":"77054","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Mammary Ductogram Or Galactogram","code_information":[{"code":"5000108","type":"CDM"},{"code":"320","type":"RC"},{"code":"77053","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Peritoneogram","code_information":[{"code":"5000133","type":"CDM"},{"code":"614","type":"RC"},{"code":"74190","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Xrination Specimen","code_information":[{"code":"5000147","type":"CDM"},{"code":"320","type":"RC"},{"code":"76098","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Sialography Rad Sup&int","code_information":[{"code":"5000153","type":"CDM"},{"code":"329","type":"RC"},{"code":"70390","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Venography Sup Sag Sinus","code_information":[{"code":"5000208","type":"CDM"},{"code":"320","type":"RC"},{"code":"75870","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5730,"maximum":5730,"gross_charge":7162,"discounted_cash":7162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5730}]}]},{"description":"Arthrex Anchor Peek 5.5x14.7mm Corkscrew","code_information":[{"code":"2800076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5700,"maximum":5700,"gross_charge":7125,"discounted_cash":7125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5700}]}]},{"description":"Ct Angio Upr Extrm W/o&w/dye","code_information":[{"code":"5000054","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":5692,"maximum":5692,"gross_charge":7115,"discounted_cash":7115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5692},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5692},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5692}]}]},{"description":"Ct Angiography Upper Extremity W/wo Cont","code_information":[{"code":"8400053","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5692,"maximum":5692,"gross_charge":7115,"discounted_cash":7115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5692},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5692},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5692}]}]},{"description":"Echo Exam Of Fetal Heart","code_information":[{"code":"5000073","type":"CDM"},{"code":"483","type":"RC"},{"code":"76826","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":950,"maximum":5679,"gross_charge":7099,"discounted_cash":7099,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5679},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5679},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5679},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Mri Brain By Tech","code_information":[{"code":"5300062","type":"CDM"},{"code":"614","type":"RC"},{"code":"70554","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5673,"maximum":5673,"gross_charge":7091,"discounted_cash":7091,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5673}]}]},{"description":"Change Of Windpipe Airway","code_information":[{"code":"1000279","type":"CDM"},{"code":"450","type":"RC"},{"code":"31502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":5668,"gross_charge":7085,"discounted_cash":7085,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5668},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5668},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5668}]}]},{"description":"Nm Gi Bleed","code_information":[{"code":"5000003","type":"CDM"},{"code":"340","type":"RC"},{"code":"78278","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Nm Bone Scan Limited","code_information":[{"code":"5000026","type":"CDM"},{"code":"340","type":"RC"},{"code":"78300","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Bone And/or Joint Imaging Multiple Areas","code_information":[{"code":"5000027","type":"CDM"},{"code":"340","type":"RC"},{"code":"78305","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Ct Angio Aorta Runoff","code_information":[{"code":"5000048","type":"CDM"},{"code":"359","type":"RC"},{"code":"75635","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Nm Hida","code_information":[{"code":"5000088","type":"CDM"},{"code":"340","type":"RC"},{"code":"78226","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Nm Hida W Kinevac","code_information":[{"code":"5000089","type":"CDM"},{"code":"340","type":"RC"},{"code":"78227","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Lymphatics And Lymph Nodes Imaging","code_information":[{"code":"5000106","type":"CDM"},{"code":"409","type":"RC"},{"code":"78195","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Nm Parathyroid Scan","code_information":[{"code":"5000124","type":"CDM"},{"code":"320","type":"RC"},{"code":"78070","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Xr Gastrointestinal Tract","code_information":[{"code":"5000144","type":"CDM"},{"code":"329","type":"RC"},{"code":"74247","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Urography Pyelography Iv W/wo Kub/tomo","code_information":[{"code":"5000192","type":"CDM"},{"code":"329","type":"RC"},{"code":"74400","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Nm Meckels Scan","code_information":[{"code":"5000276","type":"CDM"},{"code":"360","type":"RC"},{"code":"78290","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5655,"maximum":5655,"gross_charge":7069,"discounted_cash":7069,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5655}]}]},{"description":"Ct Angio Neck","code_information":[{"code":"5000052","type":"CDM"},{"code":"359","type":"RC"},{"code":"70498","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5608,"maximum":5608,"gross_charge":7010,"discounted_cash":7010,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5608},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5608},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5608}]}]},{"description":"Us Guide Compression Rep Pseudoaneurysm","code_information":[{"code":"5100031","type":"CDM"},{"code":"402","type":"RC"},{"code":"76936","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5606,"maximum":5606,"gross_charge":7008,"discounted_cash":7008,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5606},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5606},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5606}]}]},{"description":"Ct Angio Head","code_information":[{"code":"5000050","type":"CDM"},{"code":"359","type":"RC"},{"code":"70496","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5600,"maximum":5600,"gross_charge":7000,"discounted_cash":7000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5600}]}]},{"description":"Bone Bank Allograft","code_information":[{"code":"2800130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5600,"maximum":5600,"gross_charge":7000,"discounted_cash":7000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5600}]}]},{"description":"Treat Fracture Radius/ulna","code_information":[{"code":"1000025","type":"CDM"},{"code":"450","type":"RC"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":5590,"gross_charge":6988,"discounted_cash":6988,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5590}]}]},{"description":"Integra Lifesciences Finger Implant","code_information":[{"code":"2800235","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5568,"maximum":5568,"gross_charge":6960,"discounted_cash":6960,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5568},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5568},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5568}]}]},{"description":"Mr Non-joint Low Extr Wo Lt","code_information":[{"code":"5300025","type":"CDM"},{"code":"614","type":"RC"},{"code":"73718","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":5533,"maximum":5533,"gross_charge":6916,"discounted_cash":6916,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5533},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5533},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5533}]}]},{"description":"Mr Non-joint Low Extr Wo Rt","code_information":[{"code":"5300076","type":"CDM"},{"code":"614","type":"RC"},{"code":"73718","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":5533,"maximum":5533,"gross_charge":6916,"discounted_cash":6916,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5533},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5533},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5533}]}]},{"description":"Stryker 2.0 X 2.5mm Neuroflex","code_information":[{"code":"2800428","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5525,"maximum":5525,"gross_charge":6906,"discounted_cash":6906,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5525},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5525},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5525}]}]},{"description":"Treat Lower Leg Fracture","code_information":[{"code":"1000032","type":"CDM"},{"code":"450","type":"RC"},{"code":"27825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":5522,"gross_charge":6902,"discounted_cash":6902,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5522},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5522},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5522}]}]},{"description":"Egd Varices Ligation","code_information":[{"code":"2202940","type":"CDM"},{"code":"750","type":"RC"},{"code":"43244","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":5517,"gross_charge":6896,"discounted_cash":6896,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5517},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5517},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5517}]}]},{"description":"Incision Of Rectal Abscess","code_information":[{"code":"1000148","type":"CDM"},{"code":"450","type":"RC"},{"code":"46060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":5497,"gross_charge":6871,"discounted_cash":6871,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5497},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5497},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5497}]}]},{"description":"Deb Skin Bone At Fx Site","code_information":[{"code":"1000084","type":"CDM"},{"code":"450","type":"RC"},{"code":"11011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":5494,"gross_charge":6868,"discounted_cash":6868,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5494},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5494},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5494}]}]},{"description":"Delta Humeral Pe Cup Standard","code_information":[{"code":"2800154","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5489,"maximum":5489,"gross_charge":6861,"discounted_cash":6861,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5489},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5489},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5489}]}]},{"description":"Treatment Of Tibia Fracture","code_information":[{"code":"1000072","type":"CDM"},{"code":"450","type":"RC"},{"code":"27752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":5474,"gross_charge":6843,"discounted_cash":6843,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5474}]}]},{"description":"New Or Level 4 Addl 15 Mins","code_information":[{"code":"12202985","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202985","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5469,"maximum":5469,"gross_charge":6836,"discounted_cash":6836,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5469},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5469},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5469}]}]},{"description":"Stryker Polyaxial Locking Plate Talo-nav","code_information":[{"code":"2800540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5463,"maximum":5463,"gross_charge":6829,"discounted_cash":6829,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5463},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5463},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5463}]}]},{"description":"Ct Cervical Spine Wwo","code_information":[{"code":"5200014","type":"CDM"},{"code":"359","type":"RC"},{"code":"72127","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5459,"maximum":5459,"gross_charge":6824,"discounted_cash":6824,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5459},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5459},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5459}]}]},{"description":"Ct Guidance For Needle Placement","code_information":[{"code":"5200001","type":"CDM"},{"code":"352","type":"RC"},{"code":"77012","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5446,"maximum":5446,"gross_charge":6808,"discounted_cash":6808,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5446}]}]},{"description":"Proceed Ventral Patch","code_information":[{"code":"2800362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5370,"maximum":5370,"gross_charge":6713,"discounted_cash":6713,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5370}]}]},{"description":"Mr Abd Wo","code_information":[{"code":"5300006","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5334,"maximum":5334,"gross_charge":6668,"discounted_cash":6668,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5334},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5334},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5334}]}]},{"description":"Ct Thoracic Spine Wwo","code_information":[{"code":"5200038","type":"CDM"},{"code":"359","type":"RC"},{"code":"72130","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5327,"maximum":5327,"gross_charge":6659,"discounted_cash":6659,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5327},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5327},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5327}]}]},{"description":"Gastrostomy Tube Percutaneous Change","code_information":[{"code":"1000011","type":"CDM"},{"code":"450","type":"RC"},{"code":"43760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5327,"maximum":5327,"gross_charge":6659,"discounted_cash":6659,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5327},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5327},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5327}]}]},{"description":"Ct Soft Tissue Neck Wwo","code_information":[{"code":"5000059","type":"CDM"},{"code":"359","type":"RC"},{"code":"70492","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5320,"maximum":5320,"gross_charge":6650,"discounted_cash":6650,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5320},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5320},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5320}]}]},{"description":"Treat Fracture Radius & Ulna","code_information":[{"code":"1000058","type":"CDM"},{"code":"450","type":"RC"},{"code":"25565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":5316,"gross_charge":6645,"discounted_cash":6645,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5316}]}]},{"description":"Cardiac Mri W/stress Img","code_information":[{"code":"5300004","type":"CDM"},{"code":"360","type":"RC"},{"code":"75559","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5283,"maximum":5283,"gross_charge":6604,"discounted_cash":6604,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5283}]}]},{"description":"Ct Abdomen With Iv","code_information":[{"code":"5200008","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5265,"maximum":5265,"gross_charge":6581,"discounted_cash":6581,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5265},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5265},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5265}]}]},{"description":"Closed Tx Femoral Shaft Fract W/o Manip","code_information":[{"code":"1000029","type":"CDM"},{"code":"450","type":"RC"},{"code":"27500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":5239,"gross_charge":6549,"discounted_cash":6549,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5239}]}]},{"description":"Magnetic Image Jaw Joint","code_information":[{"code":"5300042","type":"CDM"},{"code":"329","type":"RC"},{"code":"70336","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5229,"maximum":5229,"gross_charge":6536,"discounted_cash":6536,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5229}]}]},{"description":"J&j Tfna Fenestrated Screw 80mm","code_information":[{"code":"2800250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5220,"maximum":5220,"gross_charge":6525,"discounted_cash":6525,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5220}]}]},{"description":"Synthes Tfna Fenestrated Screw 90mm","code_information":[{"code":"2800648","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5220,"maximum":5220,"gross_charge":6525,"discounted_cash":6525,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5220}]}]},{"description":"Ct Abdomen And Pelvis Without Contrast","code_information":[{"code":"8400065","type":"CDM"},{"code":"352","type":"RC"},{"code":"74178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5214,"maximum":5214,"gross_charge":6518,"discounted_cash":6518,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5214}]}]},{"description":"Ct Orbit/iac/sella Wwo","code_information":[{"code":"5200030","type":"CDM"},{"code":"352","type":"RC"},{"code":"70482","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5202,"maximum":5202,"gross_charge":6502,"discounted_cash":6502,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5202}]}]},{"description":"Esophagosc Dilate Balloon 31","code_information":[{"code":"2200916","type":"CDM"},{"code":"750","type":"RC"},{"code":"43214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":5202,"gross_charge":6502,"discounted_cash":6502,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5202}]}]},{"description":"Tl Medical Interbody Fusion Device","code_information":[{"code":"2800677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5200,"maximum":5200,"gross_charge":6500,"discounted_cash":6500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5200}]}]},{"description":"Ct Lumbar Spine Wo","code_information":[{"code":"5200023","type":"CDM"},{"code":"359","type":"RC"},{"code":"72131","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5192,"maximum":5192,"gross_charge":6490,"discounted_cash":6490,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5192}]}]},{"description":"Angio Existing Cath Followup Study","code_information":[{"code":"5000004","type":"CDM"},{"code":"320","type":"RC"},{"code":"75898","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5187,"maximum":5187,"gross_charge":6484,"discounted_cash":6484,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5187},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5187},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5187}]}]},{"description":"Ct Pelvis Wwo","code_information":[{"code":"5200033","type":"CDM"},{"code":"359","type":"RC"},{"code":"72194","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5187,"maximum":5187,"gross_charge":6484,"discounted_cash":6484,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5187},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5187},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5187}]}]},{"description":"Jrf Versa Graft 4.5 X 250","code_information":[{"code":"2800253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5160,"maximum":5160,"gross_charge":6450,"discounted_cash":6450,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5160}]}]},{"description":"Mri Angio Abdom W Orw/o Dye","code_information":[{"code":"5300046","type":"CDM"},{"code":"612","type":"RC"},{"code":"74185","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5144,"maximum":5144,"gross_charge":6430,"discounted_cash":6430,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5144}]}]},{"description":"Closed Tx Radial Shaft Fract W/manip","code_information":[{"code":"1000063","type":"CDM"},{"code":"450","type":"RC"},{"code":"25505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":5130,"gross_charge":6412,"discounted_cash":6412,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5130}]}]},{"description":"Ct Lower Extr With And Without Iv","code_information":[{"code":"5200021","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":5126,"maximum":5126,"gross_charge":6408,"discounted_cash":6408,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5126}]}]},{"description":"Mr Angio Or Venous Head Wo","code_information":[{"code":"5300049","type":"CDM"},{"code":"614","type":"RC"},{"code":"70544","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5106,"maximum":5106,"gross_charge":6383,"discounted_cash":6383,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5106}]}]},{"description":"Mr Angio Neck Wo","code_information":[{"code":"5300053","type":"CDM"},{"code":"614","type":"RC"},{"code":"70547","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5094,"maximum":5094,"gross_charge":6367,"discounted_cash":6367,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5094},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5094},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5094}]}]},{"description":"Closed Tx Knee Dislocation W/o Anes","code_information":[{"code":"1000039","type":"CDM"},{"code":"450","type":"RC"},{"code":"27550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":5078,"gross_charge":6347,"discounted_cash":6347,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5078},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5078},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5078}]}]},{"description":"Deb Skin Bone At Fx Site","code_information":[{"code":"1000083","type":"CDM"},{"code":"450","type":"RC"},{"code":"11010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":5076,"gross_charge":6345,"discounted_cash":6345,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5076},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5076},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5076}]}]},{"description":"Ct Thoracic Spine Wo","code_information":[{"code":"5200037","type":"CDM"},{"code":"359","type":"RC"},{"code":"72128","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5074,"maximum":5074,"gross_charge":6343,"discounted_cash":6343,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5074},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5074},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5074}]}]},{"description":"Ct Sinus/facial Wwo","code_information":[{"code":"5200027","type":"CDM"},{"code":"359","type":"RC"},{"code":"70488","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":5000,"maximum":5000,"gross_charge":6250,"discounted_cash":6250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5000}]}]},{"description":"Removal Of Foreign Body Musc/tdn Cmp","code_information":[{"code":"1000210","type":"CDM"},{"code":"450","type":"RC"},{"code":"20525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":4993,"gross_charge":6241,"discounted_cash":6241,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4993},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4993},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4993}]}]},{"description":"Closed Tx Ulnar Shaft Fract W/manip","code_information":[{"code":"1000077","type":"CDM"},{"code":"450","type":"RC"},{"code":"25535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4986,"gross_charge":6233,"discounted_cash":6233,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4986},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4986},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4986}]}]},{"description":"Tte W/o Doppler Complete","code_information":[{"code":"5100013","type":"CDM"},{"code":"483","type":"RC"},{"code":"93307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":4984,"gross_charge":6230,"discounted_cash":6230,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4984},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4984},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4984},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Ct Chest Wwo","code_information":[{"code":"5200041","type":"CDM"},{"code":"359","type":"RC"},{"code":"71270","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4967,"maximum":4967,"gross_charge":6209,"discounted_cash":6209,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4967},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4967},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4967}]}]},{"description":"Treatment Of Ankle Fracture","code_information":[{"code":"1000074","type":"CDM"},{"code":"450","type":"RC"},{"code":"27818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4956,"gross_charge":6195,"discounted_cash":6195,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4956},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4956},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4956}]}]},{"description":"Egd Balloon Dil Esoph30 Mm/>","code_information":[{"code":"2200913","type":"CDM"},{"code":"750","type":"RC"},{"code":"43233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4934,"gross_charge":6167,"discounted_cash":6167,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4934},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4934},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4934}]}]},{"description":"Stryker Allografct Evans Wedge 8x22x20mm","code_information":[{"code":"2800448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4928,"maximum":4928,"gross_charge":6160,"discounted_cash":6160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4928},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4928},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4928}]}]},{"description":"Removal Foreign Body Foot Complicated","code_information":[{"code":"1000206","type":"CDM"},{"code":"450","type":"RC"},{"code":"28193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":4918,"gross_charge":6147,"discounted_cash":6147,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4918},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4918},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4918}]}]},{"description":"Removal Foreign Body Foot Deep","code_information":[{"code":"1000207","type":"CDM"},{"code":"450","type":"RC"},{"code":"28192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4918,"gross_charge":6147,"discounted_cash":6147,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4918},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4918},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4918}]}]},{"description":"Mentor Implant 380cc High Profile","code_information":[{"code":"2800303","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4912,"maximum":4912,"gross_charge":6140,"discounted_cash":6140,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4912},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4912},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4912}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"2200560","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4898,"gross_charge":6122,"discounted_cash":6122,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4898}]}]},{"description":"Colonoscopy W/control Bleed","code_information":[{"code":"2200561","type":"CDM"},{"code":"750","type":"RC"},{"code":"45382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4898,"gross_charge":6122,"discounted_cash":6122,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4898}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"2200562","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4898,"gross_charge":6122,"discounted_cash":6122,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4898}]}]},{"description":"Colonoscopy Submucous Njx","code_information":[{"code":"2200563","type":"CDM"},{"code":"750","type":"RC"},{"code":"45381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4898,"gross_charge":6122,"discounted_cash":6122,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4898}]}]},{"description":"Colonoscopy W/lesion Removal","code_information":[{"code":"2200564","type":"CDM"},{"code":"750","type":"RC"},{"code":"45384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4898,"gross_charge":6122,"discounted_cash":6122,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4898}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"2200565","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4898,"gross_charge":6122,"discounted_cash":6122,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4898}]}]},{"description":"Cmplx Rpr E/n/e/l 2.6-7.5 Cm","code_information":[{"code":"1000222","type":"CDM"},{"code":"450","type":"RC"},{"code":"13152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":4887,"gross_charge":6109,"discounted_cash":6109,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4887},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4887},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4887}]}]},{"description":"CT scan of abdomen and pelvis with contrast","code_information":[{"code":"8400064","type":"CDM"},{"code":"350","type":"RC"},{"code":"74177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4882,"maximum":4882,"gross_charge":6103,"discounted_cash":6103,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4882},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4882},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4882}]}]},{"description":"Ct Head Wwo","code_information":[{"code":"5200015","type":"CDM"},{"code":"359","type":"RC"},{"code":"70470","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4881,"maximum":4881,"gross_charge":6101,"discounted_cash":6101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4881},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4881},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4881}]}]},{"description":"Ct Chest W","code_information":[{"code":"5200039","type":"CDM"},{"code":"359","type":"RC"},{"code":"71260","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4872,"maximum":4872,"gross_charge":6090,"discounted_cash":6090,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4872}]}]},{"description":"Cardiac Mri For Morph","code_information":[{"code":"5300003","type":"CDM"},{"code":"360","type":"RC"},{"code":"75557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5300009","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"Mr Joint Upper Extr Wo Lt","code_information":[{"code":"5300012","type":"CDM"},{"code":"614","type":"RC"},{"code":"73221","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"Mri Open Intracranial Proc W/wo Dye","code_information":[{"code":"5300016","type":"CDM"},{"code":"614","type":"RC"},{"code":"70557","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"Mr Brain Wo","code_information":[{"code":"5300019","type":"CDM"},{"code":"614","type":"RC"},{"code":"70551","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"Mr Chest Wo","code_information":[{"code":"5300022","type":"CDM"},{"code":"614","type":"RC"},{"code":"71550","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"Mr Orbs/face/neck Wo","code_information":[{"code":"5300028","type":"CDM"},{"code":"614","type":"RC"},{"code":"70540","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"Magnetic Resonance Procedure","code_information":[{"code":"5300067","type":"CDM"},{"code":"614","type":"RC"},{"code":"76498","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5300070","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"Mr Joint Upper Extr Wo Rt","code_information":[{"code":"5300073","type":"CDM"},{"code":"614","type":"RC"},{"code":"73221","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":4869,"maximum":4869,"gross_charge":6086,"discounted_cash":6086,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4869}]}]},{"description":"Ct Angio Chest","code_information":[{"code":"5000049","type":"CDM"},{"code":"359","type":"RC"},{"code":"71275","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4864,"maximum":4864,"gross_charge":6080,"discounted_cash":6080,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4864}]}]},{"description":"Stryker  2x2 Cm Allo Wrap (Per Sq Cm)","code_information":[{"code":"2800418","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4864,"maximum":4864,"gross_charge":6080,"discounted_cash":6080,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4864}]}]},{"description":"Cmplx Rpr F/c/c/m/n/ax/g/h/f","code_information":[{"code":"1000225","type":"CDM"},{"code":"450","type":"RC"},{"code":"13132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":4864,"gross_charge":6080,"discounted_cash":6080,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4864}]}]},{"description":"Open Tx Nose Fx Uncomplicatd","code_information":[{"code":"1000190","type":"CDM"},{"code":"450","type":"RC"},{"code":"21325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":4854,"gross_charge":6067,"discounted_cash":6067,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4854},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4854},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4854}]}]},{"description":"Ercp W/specimen Collection","code_information":[{"code":"2200873","type":"CDM"},{"code":"750","type":"RC"},{"code":"43260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4850,"gross_charge":6062,"discounted_cash":6062,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4850},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4850},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4850}]}]},{"description":"Ct Upper Extr Wwo","code_information":[{"code":"5200044","type":"CDM"},{"code":"352","type":"RC"},{"code":"73202","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":4835,"maximum":4835,"gross_charge":6044,"discounted_cash":6044,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4835}]}]},{"description":"Ct Angio Abd With And Without Iv","code_information":[{"code":"5000047","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4834,"maximum":4834,"gross_charge":6043,"discounted_cash":6043,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4834}]}]},{"description":"Ecg Transthoracic","code_information":[{"code":"4200020","type":"CDM"},{"code":"730","type":"RC"},{"code":"93306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":4829,"gross_charge":6036,"discounted_cash":6036,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4829},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4829},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4829},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Treatment Of Ankle Fracture","code_information":[{"code":"1000014","type":"CDM"},{"code":"450","type":"RC"},{"code":"27810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4813,"gross_charge":6016,"discounted_cash":6016,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4813},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4813},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4813}]}]},{"description":"Acumed 8-hole Clavicle Plate","code_information":[{"code":"2800046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4804,"maximum":4804,"gross_charge":6005,"discounted_cash":6005,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4804},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4804},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4804}]}]},{"description":"Zavation 2 Level Plate","code_information":[{"code":"2800716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4800,"maximum":4800,"gross_charge":6000,"discounted_cash":6000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4800}]}]},{"description":"Ct Angio Lwr Extr W/o&w/dye","code_information":[{"code":"5000051","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":4793,"maximum":4793,"gross_charge":5991,"discounted_cash":5991,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4793},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4793},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4793}]}]},{"description":"Ct Angio Pelvis","code_information":[{"code":"5000053","type":"CDM"},{"code":"359","type":"RC"},{"code":"72191","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":4793,"maximum":4793,"gross_charge":5991,"discounted_cash":5991,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4793},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4793},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4793}]}]},{"description":"Cv Telemetry >24 Hours Accessible 48456","code_information":[{"code":"4200012","type":"CDM"},{"code":"740","type":"RC"},{"code":"93229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":4788,"gross_charge":5985,"discounted_cash":5985,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4788},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4788},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4788},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Ct Abdomen Without Iv","code_information":[{"code":"5200009","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4773,"maximum":4773,"gross_charge":5966,"discounted_cash":5966,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4773},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4773},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4773}]}]},{"description":"Esoph Egd Dilation <30 Mm","code_information":[{"code":"2202939","type":"CDM"},{"code":"750","type":"RC"},{"code":"43249","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4759,"gross_charge":5949,"discounted_cash":5949,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4759},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4759},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4759}]}]},{"description":"Egd Control Bleeding Any","code_information":[{"code":"2202942","type":"CDM"},{"code":"750","type":"RC"},{"code":"43255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4759,"gross_charge":5949,"discounted_cash":5949,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4759},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4759},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4759}]}]},{"description":"Egd Cautery Tumor Polyp","code_information":[{"code":"2202947","type":"CDM"},{"code":"750","type":"RC"},{"code":"43250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4759,"gross_charge":5949,"discounted_cash":5949,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4759},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4759},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4759}]}]},{"description":"Ct Lumbar Spine W","code_information":[{"code":"5200022","type":"CDM"},{"code":"359","type":"RC"},{"code":"72132","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4758,"maximum":4758,"gross_charge":5947,"discounted_cash":5947,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4758},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4758},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4758}]}]},{"description":"Zimmer Prolong Highly Crosslinked Polyet","code_information":[{"code":"2800736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4750,"maximum":4750,"gross_charge":5938,"discounted_cash":5938,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4750},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4750},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4750}]}]},{"description":"I&d Deep Abscess/hema Sft Tis Head/neck","code_information":[{"code":"1000153","type":"CDM"},{"code":"450","type":"RC"},{"code":"21501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4731,"gross_charge":5914,"discounted_cash":5914,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4731},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4731},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4731}]}]},{"description":"Ct Thoracic Spine W","code_information":[{"code":"5200036","type":"CDM"},{"code":"359","type":"RC"},{"code":"72129","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4728,"maximum":4728,"gross_charge":5910,"discounted_cash":5910,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4728},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4728},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4728}]}]},{"description":"Arthtrex Knotless Tightrope Syndesmosis","code_information":[{"code":"2800103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4700,"maximum":4700,"gross_charge":5875,"discounted_cash":5875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4700}]}]},{"description":"Cardinal Health Ventral Small Patch Mesh","code_information":[{"code":"2800134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4699,"maximum":4699,"gross_charge":5874,"discounted_cash":5874,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4699},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4699},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4699}]}]},{"description":"Ct Cervical Spine W","code_information":[{"code":"5200012","type":"CDM"},{"code":"359","type":"RC"},{"code":"72126","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4690,"maximum":4690,"gross_charge":5862,"discounted_cash":5862,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4690}]}]},{"description":"Ct Cervical Spine With Contrast Material","code_information":[{"code":"8400040","type":"CDM"},{"code":"359","type":"RC"},{"code":"72126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4690,"maximum":4690,"gross_charge":5862,"discounted_cash":5862,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4690}]}]},{"description":"Stryker Dbm Plus Putty","code_information":[{"code":"2800483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4680,"maximum":4680,"gross_charge":5850,"discounted_cash":5850,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4680},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4680},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4680}]}]},{"description":"Synthes 4 Hole Dhsplate","code_information":[{"code":"2800610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4668,"maximum":4668,"gross_charge":5835,"discounted_cash":5835,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4668},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4668},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4668}]}]},{"description":"Treat Ulnar Fracture","code_information":[{"code":"1000075","type":"CDM"},{"code":"450","type":"RC"},{"code":"24675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4654,"gross_charge":5817,"discounted_cash":5817,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4654}]}]},{"description":"Repair Lip Full Thickness Vermilion Only","code_information":[{"code":"1000243","type":"CDM"},{"code":"450","type":"RC"},{"code":"40650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":4642,"gross_charge":5802,"discounted_cash":5802,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4642},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4642},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4642}]}]},{"description":"Angiography Slct Ea Add Vsl Studied","code_information":[{"code":"5000015","type":"CDM"},{"code":"320","type":"RC"},{"code":"75774","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4636,"maximum":4636,"gross_charge":5795,"discounted_cash":5795,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4636}]}]},{"description":"Treat Wrist Bone Fracture","code_information":[{"code":"1000016","type":"CDM"},{"code":"450","type":"RC"},{"code":"25635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4630,"gross_charge":5788,"discounted_cash":5788,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4630},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4630},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4630}]}]},{"description":"Treat Metacarpal Fracture","code_information":[{"code":"1000045","type":"CDM"},{"code":"450","type":"RC"},{"code":"26607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4618,"gross_charge":5772,"discounted_cash":5772,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4618},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4618},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4618}]}]},{"description":"Mri Spectroscopy","code_information":[{"code":"5300066","type":"CDM"},{"code":"615","type":"RC"},{"code":"76390","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4607,"maximum":4607,"gross_charge":5759,"discounted_cash":5759,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4607}]}]},{"description":"Alliance Spine Cervical Plate 14x16x2","code_information":[{"code":"2800058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4600,"maximum":4600,"gross_charge":5750,"discounted_cash":5750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4600}]}]},{"description":"Corelink Rb Cannulated Screw 5.5x40","code_information":[{"code":"2800142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4600,"maximum":4600,"gross_charge":5750,"discounted_cash":5750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4600}]}]},{"description":"Corelink Rb Cannulated Screw 6.5x45","code_information":[{"code":"2800143","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4600,"maximum":4600,"gross_charge":5750,"discounted_cash":5750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4600}]}]},{"description":"Ctl Amedica  Poly-axial Semi Closed Scre","code_information":[{"code":"2800148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4600,"maximum":4600,"gross_charge":5750,"discounted_cash":5750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4600}]}]},{"description":"Ethicon Mesh 30x30","code_information":[{"code":"2802718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4600,"maximum":4600,"gross_charge":5750,"discounted_cash":5750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4600}]}]},{"description":"Insert Pleural Cath","code_information":[{"code":"8400267","type":"CDM"},{"code":"450","type":"RC"},{"code":"32550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4580,"gross_charge":5725,"discounted_cash":5725,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4580},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4580},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4580}]}]},{"description":"Pattella Medialized Dome18mm *38 Mm","code_information":[{"code":"27000113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4562,"maximum":4562,"gross_charge":5702,"discounted_cash":5702,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4562},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4562},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4562}]}]},{"description":"Ventralight St Mesh With Balloon Positio","code_information":[{"code":"2800690","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4560,"maximum":4560,"gross_charge":5700,"discounted_cash":5700,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4560},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4560},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4560}]}]},{"description":"Insj Picc Rs&i 5 Yr+","code_information":[{"code":"2201575","type":"CDM"},{"code":"940","type":"RC"},{"code":"36573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":4526,"gross_charge":5657,"discounted_cash":5657,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4526},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Treat Wrist Dislocation","code_information":[{"code":"1000027","type":"CDM"},{"code":"450","type":"RC"},{"code":"25675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4522,"gross_charge":5653,"discounted_cash":5653,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4522},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4522},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4522}]}]},{"description":"Corpora Cavernosography Rad Sup&int","code_information":[{"code":"5000057","type":"CDM"},{"code":"329","type":"RC"},{"code":"74445","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Cystography Minimum 3 Views Rad Sup&int","code_information":[{"code":"5000060","type":"CDM"},{"code":"329","type":"RC"},{"code":"74430","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Perine/vaginogram To Determine Sex/anom","code_information":[{"code":"5000132","type":"CDM"},{"code":"329","type":"RC"},{"code":"74775","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Urethrocystograph Retrograde Radsup&int","code_information":[{"code":"5000190","type":"CDM"},{"code":"329","type":"RC"},{"code":"74450","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Urethrocystography Voiding Rad Sup&int","code_information":[{"code":"5000191","type":"CDM"},{"code":"329","type":"RC"},{"code":"74455","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Urographant/pyelosto/nephrosto Loop","code_information":[{"code":"5000193","type":"CDM"},{"code":"329","type":"RC"},{"code":"74425","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Urography Infusion Drip Technique","code_information":[{"code":"5000194","type":"CDM"},{"code":"329","type":"RC"},{"code":"74410","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Urography Infusion Drip","code_information":[{"code":"5000195","type":"CDM"},{"code":"329","type":"RC"},{"code":"74415","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Urography Retrograde W/wo Kub","code_information":[{"code":"5000196","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Vaso Vesiculography Or Epididymography","code_information":[{"code":"5000197","type":"CDM"},{"code":"329","type":"RC"},{"code":"74440","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4510,"maximum":4510,"gross_charge":5637,"discounted_cash":5637,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4510}]}]},{"description":"Arthrex Implant System Acute Ac Repair","code_information":[{"code":"2800086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4500,"maximum":4500,"gross_charge":5625,"discounted_cash":5625,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4500}]}]},{"description":"Mri Breast W/wo Contrast Unilateral","code_information":[{"code":"5300065","type":"CDM"},{"code":"614","type":"RC"},{"code":"77058","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":4478,"maximum":4478,"gross_charge":5598,"discounted_cash":5598,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4478}]}]},{"description":"Treat Radius Fracture","code_information":[{"code":"1000060","type":"CDM"},{"code":"450","type":"RC"},{"code":"24655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4478,"gross_charge":5597,"discounted_cash":5597,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4478}]}]},{"description":"Catheter, Hemodialysis/peritoneal, Long-","code_information":[{"code":"81000761","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4438,"maximum":4438,"gross_charge":5547,"discounted_cash":5547,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4438}]}]},{"description":"Stryker Easyclip Fixation Device 20x16x1","code_information":[{"code":"2800491","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4405,"maximum":4405,"gross_charge":5506,"discounted_cash":5506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4405}]}]},{"description":"Ct Thorax Lung Cancer Scr C-","code_information":[{"code":"5000058","type":"CDM"},{"code":"352","type":"RC"},{"code":"71271","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4401,"maximum":4401,"gross_charge":5501,"discounted_cash":5501,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4401}]}]},{"description":"Ct Low Dose Chest Wo","code_information":[{"code":"5200045","type":"CDM"},{"code":"352","type":"RC"},{"code":"G0297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4401,"maximum":4401,"gross_charge":5501,"discounted_cash":5501,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4401}]}]},{"description":"Arthrex Impl Delivery Sys Distal Biceps","code_information":[{"code":"2800085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Elements 14x11x7  Cage","code_information":[{"code":"2800374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Elements 14x11x7 Cage","code_information":[{"code":"2800375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Elements 14x11x8 Cage","code_information":[{"code":"2800376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Elements 16mm X13x6mm Cage","code_information":[{"code":"2800378","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Elements 16x13x7 Cage","code_information":[{"code":"2800379","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Elements 16x13x7mm 0degree Cage","code_information":[{"code":"2800380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Elements 16x13x8mm","code_information":[{"code":"2800381","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Elements 8mm 16x13x7 Cage","code_information":[{"code":"2800398","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Spinal Evolution 16x13x7mm 0 Degree Cage","code_information":[{"code":"2800399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Zavation Cervical Interbody System","code_information":[{"code":"2800722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Zavation Ti3z Cervical Interbody  System","code_information":[{"code":"2800731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Zavation Ti3z Cervical Interbody System","code_information":[{"code":"2800732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Degen 7x14x12 Cage","code_information":[{"code":"28007574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Degen 6x16x14 Cage","code_information":[{"code":"28007575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"50mm 3lev Plate","code_information":[{"code":"28007576","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"6x14x12 Cage","code_information":[{"code":"28007577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4400,"maximum":4400,"gross_charge":5500,"discounted_cash":5500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4400}]}]},{"description":"Colonoscopy Thru Stoma Spx","code_information":[{"code":"2200555","type":"CDM"},{"code":"750","type":"RC"},{"code":"44388","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4398,"gross_charge":5497,"discounted_cash":5497,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4398}]}]},{"description":"Stryker Medium Hammertoe Implant","code_information":[{"code":"2800533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4397,"maximum":4397,"gross_charge":5496,"discounted_cash":5496,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4397},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4397},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4397}]}]},{"description":"Stryker Small Hammertoe Implant","code_information":[{"code":"2800547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4397,"maximum":4397,"gross_charge":5496,"discounted_cash":5496,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4397},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4397},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4397}]}]},{"description":"J&j 1.5mm Val Straight 12 Hole Plate","code_information":[{"code":"2800807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4396,"maximum":4396,"gross_charge":5495,"discounted_cash":5495,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4396},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4396},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4396}]}]},{"description":"Ct Lumbar Spine With Contrast Material","code_information":[{"code":"8400045","type":"CDM"},{"code":"359","type":"RC"},{"code":"72132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4389,"maximum":4389,"gross_charge":5486,"discounted_cash":5486,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4389},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4389},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4389}]}]},{"description":"Lifenet Health Theraskin (Allograft Fote","code_information":[{"code":"2800279","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4380,"maximum":4380,"gross_charge":5475,"discounted_cash":5475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4380},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4380},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4380}]}]},{"description":"Arthrex Cpr Mini Scorpion Dx","code_information":[{"code":"2800761","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4380,"maximum":4380,"gross_charge":5475,"discounted_cash":5475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4380},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4380},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4380}]}]},{"description":"Cmplx Rpr S/a/l 1.1-2.5 Cm","code_information":[{"code":"1000228","type":"CDM"},{"code":"361","type":"RC"},{"code":"13121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":4374,"gross_charge":5467,"discounted_cash":5467,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4374},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4374},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4374}]}]},{"description":"Ct Angiography Lower Ext W/wo Contrast","code_information":[{"code":"8400057","type":"CDM"},{"code":"359","type":"RC"},{"code":"73706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4353,"maximum":4353,"gross_charge":5441,"discounted_cash":5441,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4353},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4353},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4353}]}]},{"description":"Color Flow Velocity Mapping","code_information":[{"code":"5100002","type":"CDM"},{"code":"483","type":"RC"},{"code":"93325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":4330,"gross_charge":5413,"discounted_cash":5413,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4330},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4330},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4330},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Cmplx Rpr E/n/e/l 1.1-2.5 Cm","code_information":[{"code":"1000221","type":"CDM"},{"code":"450","type":"RC"},{"code":"13151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":4306,"gross_charge":5382,"discounted_cash":5382,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4306}]}]},{"description":"Ct Guidance For Stereotactic Local","code_information":[{"code":"5200003","type":"CDM"},{"code":"352","type":"RC"},{"code":"77011","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4296,"maximum":4296,"gross_charge":5370,"discounted_cash":5370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4296}]}]},{"description":"Endovenous Ablation Ther Incompeten Vein","code_information":[{"code":"2200888","type":"CDM"},{"code":"360","type":"RC"},{"code":"36476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4283,"gross_charge":5354,"discounted_cash":5354,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4283}]}]},{"description":"Critical Care First Hour","code_information":[{"code":"1000081","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4250,"maximum":4250,"gross_charge":5312,"discounted_cash":5312,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4250}]}]},{"description":"Critical Care First Hour","code_information":[{"code":"1000082","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":4250,"gross_charge":5312,"discounted_cash":5312,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Ct Cervical Spine W/wo Contrast","code_information":[{"code":"8400041","type":"CDM"},{"code":"359","type":"RC"},{"code":"72127","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4234,"maximum":4234,"gross_charge":5292,"discounted_cash":5292,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4234}]}]},{"description":"Treat Knuckle Dislocation","code_information":[{"code":"1000046","type":"CDM"},{"code":"450","type":"RC"},{"code":"26705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4216,"gross_charge":5270,"discounted_cash":5270,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4216}]}]},{"description":"Ct Thoracic Spine With Contrast Material","code_information":[{"code":"8400043","type":"CDM"},{"code":"359","type":"RC"},{"code":"72129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4201,"maximum":4201,"gross_charge":5251,"discounted_cash":5251,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4201},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4201},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4201}]}]},{"description":"Ct Guid For Parenchymal Tissue Ablation","code_information":[{"code":"5200004","type":"CDM"},{"code":"352","type":"RC"},{"code":"77013","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4192,"maximum":4192,"gross_charge":5240,"discounted_cash":5240,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4192}]}]},{"description":"Ct Angiography Abdomen W/wo Contrast","code_information":[{"code":"8400062","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4184,"maximum":4184,"gross_charge":5230,"discounted_cash":5230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4184}]}]},{"description":"Aris Transobturator Kit","code_information":[{"code":"2800065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4180,"maximum":4180,"gross_charge":5225,"discounted_cash":5225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4180}]}]},{"description":"Mri W/o Fol W/cont Breast Bilat","code_information":[{"code":"5300060","type":"CDM"},{"code":"614","type":"RC"},{"code":"C8908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4179,"maximum":4179,"gross_charge":5224,"discounted_cash":5224,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4179},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4179},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4179}]}]},{"description":"Mri Breast C-+ W/cad Bi","code_information":[{"code":"5400001","type":"CDM"},{"code":"614","type":"RC"},{"code":"77049","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4179,"maximum":4179,"gross_charge":5224,"discounted_cash":5224,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4179},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4179},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4179}]}]},{"description":"Magnetic Image Bone Marrow","code_information":[{"code":"5300014","type":"CDM"},{"code":"614","type":"RC"},{"code":"77084","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4170,"maximum":4170,"gross_charge":5213,"discounted_cash":5213,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4170}]}]},{"description":"Treat Wrist Dislocation","code_information":[{"code":"1000064","type":"CDM"},{"code":"450","type":"RC"},{"code":"25660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4164,"gross_charge":5205,"discounted_cash":5205,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4164},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4164},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4164}]}]},{"description":"Stryker Anchorage Plate Mtp V1 Left","code_information":[{"code":"2800464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4147,"maximum":4147,"gross_charge":5184,"discounted_cash":5184,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4147}]}]},{"description":"Stryker Achor Lapidus Plate Mm","code_information":[{"code":"2800754","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4144,"maximum":4144,"gross_charge":5180,"discounted_cash":5180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4144}]}]},{"description":"Intmd Rpr N-hf/genit12.6-21","code_information":[{"code":"1000236","type":"CDM"},{"code":"450","type":"RC"},{"code":"12045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4120,"gross_charge":5150,"discounted_cash":5150,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4120}]}]},{"description":"Ct Soft Tissue Neck Wo","code_information":[{"code":"5200035","type":"CDM"},{"code":"359","type":"RC"},{"code":"70490","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4112,"maximum":4112,"gross_charge":5140,"discounted_cash":5140,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4112}]}]},{"description":"Ct Head Or Brain With Iv","code_information":[{"code":"5200016","type":"CDM"},{"code":"359","type":"RC"},{"code":"70460","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4096,"maximum":4096,"gross_charge":5120,"discounted_cash":5120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4096}]}]},{"description":"Ct Lower Extr With Iv","code_information":[{"code":"5200019","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":4096,"maximum":4096,"gross_charge":5120,"discounted_cash":5120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4096}]}]},{"description":"Ct Sinus/facial W","code_information":[{"code":"5200025","type":"CDM"},{"code":"359","type":"RC"},{"code":"70487","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4096,"maximum":4096,"gross_charge":5120,"discounted_cash":5120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4096}]}]},{"description":"Ct Orbit/iac/sella W","code_information":[{"code":"5200028","type":"CDM"},{"code":"359","type":"RC"},{"code":"70481","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4096,"maximum":4096,"gross_charge":5120,"discounted_cash":5120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4096}]}]},{"description":"CT scan of pelvis with contrast","code_information":[{"code":"5200031","type":"CDM"},{"code":"350","type":"RC"},{"code":"72193","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4096,"maximum":4096,"gross_charge":5120,"discounted_cash":5120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4096}]}]},{"description":"Ct Soft Tissue Neck W","code_information":[{"code":"5200034","type":"CDM"},{"code":"359","type":"RC"},{"code":"70491","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4096,"maximum":4096,"gross_charge":5120,"discounted_cash":5120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4096}]}]},{"description":"Ct Upper Extr W","code_information":[{"code":"5200042","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":4096,"maximum":4096,"gross_charge":5120,"discounted_cash":5120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4096}]}]},{"description":"Treat Shoulder Dislocation","code_information":[{"code":"1000066","type":"CDM"},{"code":"450","type":"RC"},{"code":"23655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4062,"gross_charge":5077,"discounted_cash":5077,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4062}]}]},{"description":"Egd Remove Lesion Snare","code_information":[{"code":"2202948","type":"CDM"},{"code":"750","type":"RC"},{"code":"43251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":4050,"gross_charge":5063,"discounted_cash":5063,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4050},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4050},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4050}]}]},{"description":"Perc Transhepatic Dil Bili Duc Stricture","code_information":[{"code":"5000129","type":"CDM"},{"code":"329","type":"RC"},{"code":"74363","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4045,"maximum":4045,"gross_charge":5056,"discounted_cash":5056,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4045},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4045},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4045}]}]},{"description":"Cmplx Rpr Trunk 2.6-7.5 Cm","code_information":[{"code":"1000231","type":"CDM"},{"code":"450","type":"RC"},{"code":"13101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":4040,"gross_charge":5050,"discounted_cash":5050,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4040},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4040},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4040}]}]},{"description":"Radiotherapy Dose Plan Imrt","code_information":[{"code":"5000091","type":"CDM"},{"code":"329","type":"RC"},{"code":"77301","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4039,"maximum":4039,"gross_charge":5049,"discounted_cash":5049,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4039},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4039},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4039}]}]},{"description":"Set Radiation Therapy Field","code_information":[{"code":"5000165","type":"CDM"},{"code":"329","type":"RC"},{"code":"77295","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4039,"maximum":4039,"gross_charge":5049,"discounted_cash":5049,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4039},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4039},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4039}]}]},{"description":"Drainage Finger Abscess Comp Felon","code_information":[{"code":"1000097","type":"CDM"},{"code":"450","type":"RC"},{"code":"26011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":4038,"gross_charge":5048,"discounted_cash":5048,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4038},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4038},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4038}]}]},{"description":"Ct Orbit Slla/pst Fss/ot Mid/in Ear Wo/c","code_information":[{"code":"8400026","type":"CDM"},{"code":"352","type":"RC"},{"code":"70482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4034,"maximum":4034,"gross_charge":5042,"discounted_cash":5042,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4034},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4034},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4034}]}]},{"description":"5 Cc Putty","code_information":[{"code":"2800018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Boston Scientific Infinion 50cm 17 Conta","code_information":[{"code":"2800131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Human Allograft Tissue Per Cc","code_information":[{"code":"2800229","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Nevro Trial Lead Kit","code_information":[{"code":"2800335","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Nevro Trial Lead Kit..","code_information":[{"code":"2800336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Spinal Graft Sr Cortical 6x11x11mm","code_information":[{"code":"2800401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Spinal Graft Technologies Allograft 8x11","code_information":[{"code":"2800402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Spinal Graft Technologies Allograft 9x11","code_information":[{"code":"2800403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Spinal Graft Technologies Cortical Block","code_information":[{"code":"2800404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Spinal Graft Technologies Graft","code_information":[{"code":"2800405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4000,"maximum":4000,"gross_charge":5000,"discounted_cash":5000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4000}]}]},{"description":"Physical Therapy Treatment","code_information":[{"code":"1000284","type":"CDM"},{"code":"450","type":"RC"},{"code":"19499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3999,"gross_charge":4999,"discounted_cash":4999,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3999},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3999},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3999}]}]},{"description":"Unlisted Procedure Breast","code_information":[{"code":"8400137","type":"CDM"},{"code":"450","type":"RC"},{"code":"19499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3999,"gross_charge":4999,"discounted_cash":4999,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3999},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3999},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3999}]}]},{"description":"Dtap Vaccine Administered < 7 Years","code_information":[{"code":"1000092","type":"CDM"},{"code":"450","type":"RC"},{"code":"90700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3993,"maximum":3993,"gross_charge":4991,"discounted_cash":4991,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3993},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3993},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3993}]}]},{"description":"Diphtheria Toxoid For Intramuscular Use","code_information":[{"code":"1000091","type":"CDM"},{"code":"450","type":"RC"},{"code":"90719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3993,"maximum":3993,"gross_charge":4991,"discounted_cash":4991,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3993},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3993},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3993}]}]},{"description":"Intmd Rpr S/a/t/ext 12.6-21","code_information":[{"code":"1000240","type":"CDM"},{"code":"450","type":"RC"},{"code":"12035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3976,"gross_charge":4970,"discounted_cash":4970,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3976},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3976},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3976}]}]},{"description":"Cmplx Rpr F/c/c/m/n/ax/g/h/f","code_information":[{"code":"1000224","type":"CDM"},{"code":"450","type":"RC"},{"code":"13131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3942,"gross_charge":4927,"discounted_cash":4927,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3942},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3942},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3942}]}]},{"description":"Ct Sinus/facial Wo","code_information":[{"code":"5200026","type":"CDM"},{"code":"359","type":"RC"},{"code":"70486","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3909,"maximum":3909,"gross_charge":4886,"discounted_cash":4886,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3909}]}]},{"description":"Tenotomy Flexor Palm Open Each Tendon","code_information":[{"code":"1000276","type":"CDM"},{"code":"450","type":"RC"},{"code":"26450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":3902,"gross_charge":4877,"discounted_cash":4877,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3902}]}]},{"description":"Tenotomy Flexor Palm Open Each Tendon","code_information":[{"code":"8400192","type":"CDM"},{"code":"450","type":"RC"},{"code":"26450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":3902,"gross_charge":4877,"discounted_cash":4877,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3902}]}]},{"description":"Repair Of Collateral Ligament Mcp/ip Jnt","code_information":[{"code":"8400194","type":"CDM"},{"code":"450","type":"RC"},{"code":"26540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":3902,"gross_charge":4877,"discounted_cash":4877,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3902}]}]},{"description":"Clsd Tx Metacarpal Frct W/manp W/ext Fix","code_information":[{"code":"8400197","type":"CDM"},{"code":"450","type":"RC"},{"code":"26607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3902,"gross_charge":4877,"discounted_cash":4877,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3902}]}]},{"description":"Arthrex Speedbridge Kit","code_information":[{"code":"2800091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3900,"maximum":3900,"gross_charge":4875,"discounted_cash":4875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3900}]}]},{"description":"Monet Fixation Plate 2 Hole","code_information":[{"code":"2800318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3900,"maximum":3900,"gross_charge":4875,"discounted_cash":4875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3900}]}]},{"description":"Mr Ang Lwr Ext W Or W/o Dye","code_information":[{"code":"5300051","type":"CDM"},{"code":"618","type":"RC"},{"code":"73725","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":3900,"maximum":3900,"gross_charge":4875,"discounted_cash":4875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3900}]}]},{"description":"Ovitex 1s 6x10cm","code_information":[{"code":"2800344","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3888,"maximum":3888,"gross_charge":4860,"discounted_cash":4860,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3888},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3888},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3888}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"1000069","type":"CDM"},{"code":"450","type":"RC"},{"code":"24530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3887,"gross_charge":4859,"discounted_cash":4859,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3887},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3887},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3887}]}]},{"description":"Synthes Plate","code_information":[{"code":"2800642","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3872,"maximum":3872,"gross_charge":4840,"discounted_cash":4840,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3872}]}]},{"description":"CT scan of pelvis with contrast","code_information":[{"code":"8400049","type":"CDM"},{"code":"350","type":"RC"},{"code":"72193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3847,"maximum":3847,"gross_charge":4809,"discounted_cash":4809,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3847},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3847},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3847}]}]},{"description":"Perc Placement Drainage Catheter","code_information":[{"code":"5000126","type":"CDM"},{"code":"320","type":"RC"},{"code":"75982","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3822,"maximum":3822,"gross_charge":4778,"discounted_cash":4778,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3822}]}]},{"description":"Ct Orbit/iac/sella Wo","code_information":[{"code":"5200029","type":"CDM"},{"code":"350","type":"RC"},{"code":"70480","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3822,"maximum":3822,"gross_charge":4777,"discounted_cash":4777,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3822}]}]},{"description":"Stryker Cannulated Compression Screw 4.0","code_information":[{"code":"2800478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3816,"maximum":3816,"gross_charge":4770,"discounted_cash":4770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3816},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3816},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3816}]}]},{"description":"Stryker Cannulated Compression Screw 5.0","code_information":[{"code":"2800479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3816,"maximum":3816,"gross_charge":4770,"discounted_cash":4770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3816},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3816},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3816}]}]},{"description":"Stryker Jfx Cann 5.0 X 5.0mm Screw","code_information":[{"code":"2800503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3816,"maximum":3816,"gross_charge":4770,"discounted_cash":4770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3816},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3816},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3816}]}]},{"description":"Closed Tx Ankle Dislocation W/o Anes","code_information":[{"code":"1000012","type":"CDM"},{"code":"450","type":"RC"},{"code":"27840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3814,"gross_charge":4768,"discounted_cash":4768,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3814},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3814},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3814}]}]},{"description":"Spinal Elements 6.5x 40 Screw","code_information":[{"code":"2800388","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Spinal Elements 6.5x 50screw","code_information":[{"code":"2800389","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Spinal Elements 6.5x35 Screw","code_information":[{"code":"2800390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Spinal Elements 6.5x40 Screw","code_information":[{"code":"2800391","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Spinal Elements 6.5x40mm Screw","code_information":[{"code":"2800392","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Spinal Elements 6.5x45 Screw","code_information":[{"code":"2800393","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Spinal Elements 6.5x50 Mm Screw","code_information":[{"code":"2800394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Tl Amedica Manot Acdf Cage Titatium Smal","code_information":[{"code":"2800668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Tl Amedica Monet Acif Cage","code_information":[{"code":"2800669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3800,"maximum":3800,"gross_charge":4750,"discounted_cash":4750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3800}]}]},{"description":"Intmd Rpr Face/mm 7.6-12.5cm","code_information":[{"code":"1000235","type":"CDM"},{"code":"450","type":"RC"},{"code":"12054","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3787,"gross_charge":4734,"discounted_cash":4734,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3787},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3787},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3787}]}]},{"description":"Ct Lumbar Spine Wo/contrast","code_information":[{"code":"8400044","type":"CDM"},{"code":"320","type":"RC"},{"code":"72131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3786,"maximum":3786,"gross_charge":4732,"discounted_cash":4732,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3786}]}]},{"description":"Ligate/divide/excise Vein","code_information":[{"code":"1000186","type":"CDM"},{"code":"450","type":"RC"},{"code":"37785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":3777,"gross_charge":4721,"discounted_cash":4721,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3777},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3777},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3777}]}]},{"description":"Ligation Div &/Or Exc Varicose Vein Clst","code_information":[{"code":"8400280","type":"CDM"},{"code":"450","type":"RC"},{"code":"37785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":3777,"gross_charge":4721,"discounted_cash":4721,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3777},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3777},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3777}]}]},{"description":"Ct Pelvis Wo","code_information":[{"code":"5200032","type":"CDM"},{"code":"359","type":"RC"},{"code":"72192","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3762,"maximum":3762,"gross_charge":4702,"discounted_cash":4702,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3762},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3762},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3762}]}]},{"description":"Treat Thumb Dislocation","code_information":[{"code":"1000019","type":"CDM"},{"code":"450","type":"RC"},{"code":"26641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3750,"maximum":3750,"gross_charge":4688,"discounted_cash":4688,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3750},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3750},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3750}]}]},{"description":"Treat Elbow Dislocation","code_information":[{"code":"1000280","type":"CDM"},{"code":"450","type":"RC"},{"code":"24600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3740,"gross_charge":4675,"discounted_cash":4675,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3740},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3740},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3740}]}]},{"description":"Closed Tx Patellar Dislocation W/o Anes","code_information":[{"code":"1000052","type":"CDM"},{"code":"450","type":"RC"},{"code":"27560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3739,"gross_charge":4674,"discounted_cash":4674,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3739},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3739},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3739}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"1000013","type":"CDM"},{"code":"450","type":"RC"},{"code":"26742","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3737,"gross_charge":4671,"discounted_cash":4671,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3737},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3737},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3737}]}]},{"description":"Thyroid Uptake Single Or Multiple","code_information":[{"code":"5000327","type":"CDM"},{"code":"340","type":"RC"},{"code":"78012","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3731,"maximum":3731,"gross_charge":4664,"discounted_cash":4664,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3731},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3731},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3731}]}]},{"description":"Depuy Synthes 2.0mm Straight Plate","code_information":[{"code":"2800179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3724,"maximum":3724,"gross_charge":4655,"discounted_cash":4655,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3724},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3724},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3724}]}]},{"description":"Intmd Rpr N-hf/genit7.6-12.6","code_information":[{"code":"1000239","type":"CDM"},{"code":"450","type":"RC"},{"code":"12044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3689,"gross_charge":4611,"discounted_cash":4611,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3689},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3689},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3689}]}]},{"description":"Ct Maxillofacial Area With Contrast","code_information":[{"code":"8400028","type":"CDM"},{"code":"320","type":"RC"},{"code":"70487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3689,"maximum":3689,"gross_charge":4611,"discounted_cash":4611,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3689},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3689},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3689}]}]},{"description":"Mr Angio Spine W/o&w/dye","code_information":[{"code":"5300056","type":"CDM"},{"code":"359","type":"RC"},{"code":"72159","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3687,"maximum":3687,"gross_charge":4609,"discounted_cash":4609,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3687},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3687},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3687}]}]},{"description":"Perc Transhepatic Biliary Drainage","code_information":[{"code":"5000128","type":"CDM"},{"code":"320","type":"RC"},{"code":"75980","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3685,"maximum":3685,"gross_charge":4606,"discounted_cash":4606,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3685},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3685},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3685}]}]},{"description":"Ct Abdomen W/wo Contrast","code_information":[{"code":"8400060","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3678,"maximum":3678,"gross_charge":4598,"discounted_cash":4598,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3678},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3678},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3678}]}]},{"description":"J&j 2.0ti T-pl 2hole Head/8hole-shaft","code_information":[{"code":"2802677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3676,"maximum":3676,"gross_charge":4595,"discounted_cash":4595,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3676}]}]},{"description":"Ct Chest Wo","code_information":[{"code":"5200040","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3675,"maximum":3675,"gross_charge":4594,"discounted_cash":4594,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3675},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3675},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3675}]}]},{"description":"Grafton Plus Dbm 5cc","code_information":[{"code":"2800225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3668,"maximum":3668,"gross_charge":4585,"discounted_cash":4585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3668},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3668},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3668}]}]},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"2202941","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3661,"gross_charge":4576,"discounted_cash":4576,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3661},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3661},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3661}]}]},{"description":"Ct Angiography Chest W/wo Contrast","code_information":[{"code":"8400038","type":"CDM"},{"code":"359","type":"RC"},{"code":"71275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3658,"maximum":3658,"gross_charge":4573,"discounted_cash":4573,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3658},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3658},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3658}]}]},{"description":"CT scan","code_information":[{"code":"5200017","type":"CDM"},{"code":"350","type":"RC"},{"code":"70450","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3611,"maximum":3611,"gross_charge":4514,"discounted_cash":4514,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3611},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3611},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3611}]}]},{"description":"New Or Level 3 Addl 15 Mins","code_information":[{"code":"12202983","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202983","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3610,"maximum":3610,"gross_charge":4512,"discounted_cash":4512,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3610}]}]},{"description":"Ct Pelvis W.wo Contrast","code_information":[{"code":"8400050","type":"CDM"},{"code":"359","type":"RC"},{"code":"72194","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3607,"maximum":3607,"gross_charge":4509,"discounted_cash":4509,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3607}]}]},{"description":"Parametrics 10 Dbm","code_information":[{"code":"2800781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3600,"maximum":3600,"gross_charge":4500,"discounted_cash":4500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3600}]}]},{"description":"Ventris Ostecyte Allograft Bone Matrix","code_information":[{"code":"28007571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3600,"maximum":3600,"gross_charge":4500,"discounted_cash":4500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3600}]}]},{"description":"Renal Biopsy; Percutaneous, By Trocar Or","code_information":[{"code":"22100003","type":"CDM"},{"code":"360","type":"RC"},{"code":"50200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3599,"gross_charge":4499,"discounted_cash":4499,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3599},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3599},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3599}]}]},{"description":"Ct Thorax W/wo Contrast","code_information":[{"code":"8400037","type":"CDM"},{"code":"359","type":"RC"},{"code":"71270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3598,"maximum":3598,"gross_charge":4498,"discounted_cash":4498,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3598},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3598},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3598}]}]},{"description":"Ct Thoracic Spine Wo/contrast","code_information":[{"code":"8400042","type":"CDM"},{"code":"359","type":"RC"},{"code":"72128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3598,"maximum":3598,"gross_charge":4498,"discounted_cash":4498,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3598},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3598},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3598}]}]},{"description":"Closed Tx Clavicular Fract W/manip","code_information":[{"code":"1000020","type":"CDM"},{"code":"450","type":"RC"},{"code":"23505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3594,"gross_charge":4492,"discounted_cash":4492,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3594}]}]},{"description":"Egd Remove Foreign Body","code_information":[{"code":"2202946","type":"CDM"},{"code":"750","type":"RC"},{"code":"43247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3590,"gross_charge":4487,"discounted_cash":4487,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3590}]}]},{"description":"Cmplx Rpr S/a/l 1.1-2.5 Cm","code_information":[{"code":"1000227","type":"CDM"},{"code":"450","type":"RC"},{"code":"13120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3584,"gross_charge":4480,"discounted_cash":4480,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3584},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3584},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3584}]}]},{"description":"Treatment Of Tibia Fracture","code_information":[{"code":"1000073","type":"CDM"},{"code":"450","type":"RC"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3554,"gross_charge":4442,"discounted_cash":4442,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3554}]}]},{"description":"Intmd Rpr Face/mm 5.1-7.5 Cm","code_information":[{"code":"1000234","type":"CDM"},{"code":"450","type":"RC"},{"code":"12053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3550,"gross_charge":4437,"discounted_cash":4437,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3550},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3550},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3550}]}]},{"description":"Synthes 6 Hole Plate","code_information":[{"code":"2800619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3532,"maximum":3532,"gross_charge":4415,"discounted_cash":4415,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3532},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3532},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3532}]}]},{"description":"Depuy Synthes 4.5mm Narrow Lcp Plate 7ho","code_information":[{"code":"2800195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3524,"maximum":3524,"gross_charge":4405,"discounted_cash":4405,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3524}]}]},{"description":"Stryker Easy Clip","code_information":[{"code":"2800487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3490,"maximum":3490,"gross_charge":4362,"discounted_cash":4362,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3490},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3490},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3490}]}]},{"description":"Stryker Easyclick Fixation Device 18-14-","code_information":[{"code":"2800488","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3490,"maximum":3490,"gross_charge":4362,"discounted_cash":4362,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3490},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3490},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3490}]}]},{"description":"Intersect Propel Sinus Implant","code_information":[{"code":"2800239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3486,"maximum":3486,"gross_charge":4357,"discounted_cash":4357,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3486}]}]},{"description":"Tracheostomy Planned Separate Procedure","code_information":[{"code":"1000278","type":"CDM"},{"code":"450","type":"RC"},{"code":"31600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3478,"gross_charge":4347,"discounted_cash":4347,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3478}]}]},{"description":"Open Tx Nose Fx Uncomplicatd","code_information":[{"code":"8400154","type":"CDM"},{"code":"450","type":"RC"},{"code":"21325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":3478,"gross_charge":4347,"discounted_cash":4347,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3478}]}]},{"description":"Treat Dental Ridge Fracture","code_information":[{"code":"8400155","type":"CDM"},{"code":"450","type":"RC"},{"code":"21440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":3478,"gross_charge":4347,"discounted_cash":4347,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3478}]}]},{"description":"Tracheostomy Planned Spx","code_information":[{"code":"8400266","type":"CDM"},{"code":"450","type":"RC"},{"code":"31600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3478,"gross_charge":4347,"discounted_cash":4347,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3478},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3478}]}]},{"description":"Lwr Xtr Vasc Stdy Bilat","code_information":[{"code":"5100017","type":"CDM"},{"code":"921","type":"RC"},{"code":"93924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":3460,"gross_charge":4325,"discounted_cash":4325,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3460},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3460},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3460},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Stryker Anchor Utility Plate Straight 4","code_information":[{"code":"2800461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3454,"maximum":3454,"gross_charge":4318,"discounted_cash":4318,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3454},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3454},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3454}]}]},{"description":"Stryker Chanor Utility Plate Straight 3","code_information":[{"code":"2800481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3454,"maximum":3454,"gross_charge":4318,"discounted_cash":4318,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3454},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3454},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3454}]}]},{"description":"Acumed  8mm T Plate","code_information":[{"code":"2800757","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3448,"maximum":3448,"gross_charge":4310,"discounted_cash":4310,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3448}]}]},{"description":"Ct Lower Extr Without Iv","code_information":[{"code":"5200020","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":3447,"maximum":3447,"gross_charge":4309,"discounted_cash":4309,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3447},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3447},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3447}]}]},{"description":"Closed Tx Medial Malleo Fract W/o Manp","code_information":[{"code":"1000042","type":"CDM"},{"code":"450","type":"RC"},{"code":"27760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3446,"gross_charge":4307,"discounted_cash":4307,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3446}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"1000054","type":"CDM"},{"code":"450","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3445,"gross_charge":4306,"discounted_cash":4306,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3445},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3445},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3445}]}]},{"description":"Ct Orbit Slla/pst Fss/ot Mid/in Ear W/c","code_information":[{"code":"8400025","type":"CDM"},{"code":"359","type":"RC"},{"code":"70481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3445,"maximum":3445,"gross_charge":4306,"discounted_cash":4306,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3445},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3445},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3445}]}]},{"description":"Remove Pilonidal Cyst Exten","code_information":[{"code":"1000134","type":"CDM"},{"code":"450","type":"RC"},{"code":"11771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":3438,"gross_charge":4298,"discounted_cash":4298,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3438}]}]},{"description":"Excision Pilonidal Cyst Sinus Extensive","code_information":[{"code":"8400094","type":"CDM"},{"code":"450","type":"RC"},{"code":"11771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":3438,"gross_charge":4298,"discounted_cash":4298,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3438}]}]},{"description":"Rem Fb Musc/tend Sheath Deep Or Comp","code_information":[{"code":"8400141","type":"CDM"},{"code":"450","type":"RC"},{"code":"20525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":3438,"gross_charge":4298,"discounted_cash":4298,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3438}]}]},{"description":"I&d Deep Absc/hematoma Sft Tiss Nck/thrx","code_information":[{"code":"8400158","type":"CDM"},{"code":"450","type":"RC"},{"code":"21501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3438,"gross_charge":4298,"discounted_cash":4298,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3438}]}]},{"description":"Removal Foreign Body Deep Thigh/knee","code_information":[{"code":"8400208","type":"CDM"},{"code":"450","type":"RC"},{"code":"27372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2196,"maximum":3438,"gross_charge":4298,"discounted_cash":4298,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3438}]}]},{"description":"Cmplx Rpr Trunk 1.1-2.5 Cm","code_information":[{"code":"1000230","type":"CDM"},{"code":"450","type":"RC"},{"code":"13100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3421,"gross_charge":4276,"discounted_cash":4276,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3421},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3421},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3421}]}]},{"description":"Ct Maxillofacial Area W/wo Contrast","code_information":[{"code":"8400029","type":"CDM"},{"code":"359","type":"RC"},{"code":"70488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3420,"maximum":3420,"gross_charge":4275,"discounted_cash":4275,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3420}]}]},{"description":"Revision Subvalvular Tissue","code_information":[{"code":"1000252","type":"CDM"},{"code":"450","type":"RC"},{"code":"33415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3414,"maximum":3414,"gross_charge":4268,"discounted_cash":4268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3414},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3414},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3414}]}]},{"description":"Rescj/inc Subvalvular Tissue","code_information":[{"code":"8400271","type":"CDM"},{"code":"450","type":"RC"},{"code":"33415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3414,"maximum":3414,"gross_charge":4268,"discounted_cash":4268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3414},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3414},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3414}]}]},{"description":"Ct Abdomen Without Contrast Material","code_information":[{"code":"8400058","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3406,"maximum":3406,"gross_charge":4258,"discounted_cash":4258,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3406}]}]},{"description":"Intersect Propal Contour","code_information":[{"code":"2800238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3400,"maximum":3400,"gross_charge":4250,"discounted_cash":4250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3400}]}]},{"description":"Ethicon Mesh 3x6","code_information":[{"code":"2800201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3390,"maximum":3390,"gross_charge":4237,"discounted_cash":4237,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3390},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3390},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3390}]}]},{"description":"Ct Cervical Spine Without Contrast","code_information":[{"code":"8400039","type":"CDM"},{"code":"359","type":"RC"},{"code":"72125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3385,"maximum":3385,"gross_charge":4231,"discounted_cash":4231,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3385},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3385},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3385}]}]},{"description":"Xr Shoulder Arthrography Rad Sup&int","code_information":[{"code":"8401476","type":"CDM"},{"code":"359","type":"RC"},{"code":"73040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3378,"maximum":3378,"gross_charge":4222,"discounted_cash":4222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3378},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3378},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3378}]}]},{"description":"Treat Fracture Radius/ulna","code_information":[{"code":"1000026","type":"CDM"},{"code":"450","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3374,"gross_charge":4218,"discounted_cash":4218,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3374},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3374},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3374}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"1000057","type":"CDM"},{"code":"450","type":"RC"},{"code":"23600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3360,"gross_charge":4200,"discounted_cash":4200,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3360}]}]},{"description":"Remove Vaginal Foreign Body","code_information":[{"code":"1000214","type":"CDM"},{"code":"450","type":"RC"},{"code":"57415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3337,"gross_charge":4171,"discounted_cash":4171,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3337}]}]},{"description":"Removal Of Vaginal Foreign Object","code_information":[{"code":"8400313","type":"CDM"},{"code":"450","type":"RC"},{"code":"57415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3337,"gross_charge":4171,"discounted_cash":4171,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3337}]}]},{"description":"Vaginal Delivery Only","code_information":[{"code":"8400316","type":"CDM"},{"code":"450","type":"RC"},{"code":"59409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3337,"gross_charge":4171,"discounted_cash":4171,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3337}]}]},{"description":"Closed Tx Patellar Fract W/o Manip","code_information":[{"code":"1000053","type":"CDM"},{"code":"450","type":"RC"},{"code":"27520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3329,"gross_charge":4161,"discounted_cash":4161,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3329},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3329},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3329}]}]},{"description":"Repair Tongue Laceration","code_information":[{"code":"1000247","type":"CDM"},{"code":"450","type":"RC"},{"code":"41252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3325,"gross_charge":4156,"discounted_cash":4156,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3325}]}]},{"description":"Treat Knuckle Dislocation","code_information":[{"code":"1000047","type":"CDM"},{"code":"450","type":"RC"},{"code":"26700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3312,"maximum":3312,"gross_charge":4140,"discounted_cash":4140,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3312},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3312},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3312}]}]},{"description":"Acumed 30mm Acutrak Mini Screw","code_information":[{"code":"2800038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3300,"maximum":3300,"gross_charge":4125,"discounted_cash":4125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3300}]}]},{"description":"Treat Metacarpal Fracture","code_information":[{"code":"1000043","type":"CDM"},{"code":"450","type":"RC"},{"code":"26605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3296,"gross_charge":4120,"discounted_cash":4120,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3296}]}]},{"description":"Ct Pelvis Without Contrast Material","code_information":[{"code":"8400048","type":"CDM"},{"code":"320","type":"RC"},{"code":"72192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3268,"maximum":3268,"gross_charge":4085,"discounted_cash":4085,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3268},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3268},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3268}]}]},{"description":"Central Motor Evoked Potential Study","code_information":[{"code":"2200457","type":"CDM"},{"code":"740","type":"RC"},{"code":"95939","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":3266,"gross_charge":4083,"discounted_cash":4083,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3266},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3266},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3266},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Treatment Of Ankle Fracture","code_information":[{"code":"1000022","type":"CDM"},{"code":"450","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3262,"gross_charge":4078,"discounted_cash":4078,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3262}]}]},{"description":"Interbody Fusion Device 10mm","code_information":[{"code":"2800237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3250,"maximum":3250,"gross_charge":4063,"discounted_cash":4063,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3250}]}]},{"description":"Valeo Interbody Fusion Device 11mm","code_information":[{"code":"2800687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3250,"maximum":3250,"gross_charge":4063,"discounted_cash":4063,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3250}]}]},{"description":"Ct Angiography Neck W/con Inc Noncon","code_information":[{"code":"8400034","type":"CDM"},{"code":"359","type":"RC"},{"code":"70498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3244,"maximum":3244,"gross_charge":4055,"discounted_cash":4055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3244},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3244},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3244}]}]},{"description":"Hemodialysis Procedure With Single Evalu","code_information":[{"code":"1001286","type":"CDM"},{"code":"820","type":"RC"},{"code":"90935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":850,"maximum":3240,"gross_charge":4050,"discounted_cash":4050,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3240},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":850}]}]},{"description":"Replace G/c Tube Perc","code_information":[{"code":"1000250","type":"CDM"},{"code":"450","type":"RC"},{"code":"49450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3238,"gross_charge":4048,"discounted_cash":4048,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3238}]}]},{"description":"Ct Angiography Head W/con Inc Noncon","code_information":[{"code":"8400033","type":"CDM"},{"code":"359","type":"RC"},{"code":"70496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3230,"maximum":3230,"gross_charge":4038,"discounted_cash":4038,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3230}]}]},{"description":"Treat Shoulder Dislocation","code_information":[{"code":"1000067","type":"CDM"},{"code":"450","type":"RC"},{"code":"23650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3224,"gross_charge":4030,"discounted_cash":4030,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3224},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3224},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3224}]}]},{"description":"Intravascular Ultrasound Noncoronary","code_information":[{"code":"5000095","type":"CDM"},{"code":"320","type":"RC"},{"code":"75945","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3223,"maximum":3223,"gross_charge":4029,"discounted_cash":4029,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3223}]}]},{"description":"Gastro Endoscopic Us Sup And Interp","code_information":[{"code":"5100015","type":"CDM"},{"code":"402","type":"RC"},{"code":"76975","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3223,"maximum":3223,"gross_charge":4029,"discounted_cash":4029,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3223}]}]},{"description":"Us Prostate","code_information":[{"code":"5100062","type":"CDM"},{"code":"402","type":"RC"},{"code":"76873","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3223,"maximum":3223,"gross_charge":4029,"discounted_cash":4029,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3223}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"1000023","type":"CDM"},{"code":"450","type":"RC"},{"code":"26755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3220,"maximum":3220,"gross_charge":4025,"discounted_cash":4025,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3220}]}]},{"description":"Set Radiation Therapy Field","code_information":[{"code":"5000167","type":"CDM"},{"code":"329","type":"RC"},{"code":"77285","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3210,"maximum":3210,"gross_charge":4012,"discounted_cash":4012,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3210},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3210},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3210}]}]},{"description":"Treat Lower Leg Fracture","code_information":[{"code":"1000033","type":"CDM"},{"code":"450","type":"RC"},{"code":"27824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3196,"gross_charge":3995,"discounted_cash":3995,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3196}]}]},{"description":"Intmd Rpr S/tr/ext 7.6-12.6","code_information":[{"code":"1000242","type":"CDM"},{"code":"450","type":"RC"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3195,"gross_charge":3994,"discounted_cash":3994,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3195},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3195},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3195}]}]},{"description":"Ct Angiogrpahy","code_information":[{"code":"8401522","type":"CDM"},{"code":"359","type":"RC"},{"code":"75635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3190,"maximum":3190,"gross_charge":3987,"discounted_cash":3987,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3190}]}]},{"description":"Level Vi Pathology Gross And Micr Exam","code_information":[{"code":"4000290","type":"CDM"},{"code":"310","type":"RC"},{"code":"88309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3180,"maximum":3180,"gross_charge":3975,"discounted_cash":3975,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3180}]}]},{"description":"Stryker Distal Lateral Fibula Plate 6 Ho","code_information":[{"code":"2800486","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3164,"maximum":3164,"gross_charge":3955,"discounted_cash":3955,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3164},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3164},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3164}]}]},{"description":"Treatment Of Fibula Fracture","code_information":[{"code":"1000056","type":"CDM"},{"code":"450","type":"RC"},{"code":"27780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3160,"gross_charge":3950,"discounted_cash":3950,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3160}]}]},{"description":"Ct Lower Extremity With Contrast","code_information":[{"code":"8400055","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3154,"maximum":3154,"gross_charge":3942,"discounted_cash":3942,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3154},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3154},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3154}]}]},{"description":"Xr Myelography Lumbosacral Rad Sup&int","code_information":[{"code":"8401471","type":"CDM"},{"code":"614","type":"RC"},{"code":"72265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3152,"maximum":3152,"gross_charge":3940,"discounted_cash":3940,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3152}]}]},{"description":"Nm Bone Scan Three Phase","code_information":[{"code":"5000028","type":"CDM"},{"code":"340","type":"RC"},{"code":"78315","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3152,"maximum":3152,"gross_charge":3940,"discounted_cash":3940,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3152}]}]},{"description":"Bone And/or Joint Imaging Tomograp Spect","code_information":[{"code":"5000029","type":"CDM"},{"code":"340","type":"RC"},{"code":"78320","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3152,"maximum":3152,"gross_charge":3940,"discounted_cash":3940,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3152}]}]},{"description":"Xr Bone &/Or Joint Imaging 3 Phase Study","code_information":[{"code":"8401526","type":"CDM"},{"code":"340","type":"RC"},{"code":"78315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3152,"maximum":3152,"gross_charge":3940,"discounted_cash":3940,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3152}]}]},{"description":"Mr Angio Pelvis W/o & W/dye","code_information":[{"code":"5300055","type":"CDM"},{"code":"359","type":"RC"},{"code":"72198","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3134,"maximum":3134,"gross_charge":3918,"discounted_cash":3918,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3134}]}]},{"description":"Treat Wrist Bone Fracture","code_information":[{"code":"1000018","type":"CDM"},{"code":"450","type":"RC"},{"code":"25622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3129,"maximum":3129,"gross_charge":3911,"discounted_cash":3911,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3129}]}]},{"description":"Repair Tongue Laceration","code_information":[{"code":"1000246","type":"CDM"},{"code":"450","type":"RC"},{"code":"41251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":3124,"gross_charge":3905,"discounted_cash":3905,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3124}]}]},{"description":"Intmd Rpr S/a/t/ext 2.6-7.5","code_information":[{"code":"1000185","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3122,"gross_charge":3902,"discounted_cash":3902,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3122}]}]},{"description":"Treat Wrist Bone Fracture","code_information":[{"code":"1000017","type":"CDM"},{"code":"450","type":"RC"},{"code":"25630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3122,"gross_charge":3902,"discounted_cash":3902,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3122}]}]},{"description":"Bard Ventralight Balloon Mes 7x9","code_information":[{"code":"2800127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3121,"maximum":3121,"gross_charge":3901,"discounted_cash":3901,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3121},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3121},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3121}]}]},{"description":"Acumed 40mm Acutrak 4.7","code_information":[{"code":"2800041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3116,"maximum":3116,"gross_charge":3895,"discounted_cash":3895,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3116},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3116},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3116}]}]},{"description":"Synthes 1.0mm Strut Plate 8 Hole","code_information":[{"code":"2800555","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3104,"maximum":3104,"gross_charge":3880,"discounted_cash":3880,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3104}]}]},{"description":"Cardiopulmonary Resuscitation","code_information":[{"code":"4200001","type":"CDM"},{"code":"730","type":"RC"},{"code":"92950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":3086,"gross_charge":3858,"discounted_cash":3858,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3086},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3086},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3086},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Acumed 28mm Acutrak Mini Screw","code_information":[{"code":"2800035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3084,"maximum":3084,"gross_charge":3855,"discounted_cash":3855,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3084}]}]},{"description":"Acutrack Mini Screw 20mm","code_information":[{"code":"2800056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3084,"maximum":3084,"gross_charge":3855,"discounted_cash":3855,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3084}]}]},{"description":"Pacu 1st 30","code_information":[{"code":"2000000","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP2000000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3064,"maximum":3064,"gross_charge":3830,"discounted_cash":3830,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3064},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3064},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3064}]}]},{"description":"Midtown Pacu 1st 30","code_information":[{"code":"2000002","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP2000002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3064,"maximum":3064,"gross_charge":3830,"discounted_cash":3830,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3064},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3064},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3064}]}]},{"description":"4 Hole Straigh Plate","code_information":[{"code":"2800016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3043,"maximum":3043,"gross_charge":3804,"discounted_cash":3804,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3043}]}]},{"description":"Bard Mesh Small Plug","code_information":[{"code":"2800123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3042,"maximum":3042,"gross_charge":3802,"discounted_cash":3802,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3042},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3042},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3042}]}]},{"description":"S&n Healicoil Knotless","code_information":[{"code":"2800787","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3040,"maximum":3040,"gross_charge":3800,"discounted_cash":3800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3040},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3040},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3040}]}]},{"description":"Treat Metacarpal Fracture","code_information":[{"code":"1000044","type":"CDM"},{"code":"450","type":"RC"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3024,"maximum":3024,"gross_charge":3780,"discounted_cash":3780,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3024},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3024},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3024}]}]},{"description":"Ct Maxillofacial Area Without Contrast","code_information":[{"code":"8400027","type":"CDM"},{"code":"320","type":"RC"},{"code":"70486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3023,"maximum":3023,"gross_charge":3779,"discounted_cash":3779,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Intmd Rpr Face/mm 2.6-5.0 Cm","code_information":[{"code":"1000233","type":"CDM"},{"code":"450","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":3006,"gross_charge":3757,"discounted_cash":3757,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3006},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3006},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3006}]}]},{"description":"Boston Scientific Stent 6x26","code_information":[{"code":"2802717","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3000,"maximum":3000,"gross_charge":3750,"discounted_cash":3750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3000}]}]},{"description":"Treat Ulnar Fracture","code_information":[{"code":"1000076","type":"CDM"},{"code":"450","type":"RC"},{"code":"24670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2990,"gross_charge":3737,"discounted_cash":3737,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2990},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2990},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2990}]}]},{"description":"CT scan","code_information":[{"code":"8400021","type":"CDM"},{"code":"350","type":"RC"},{"code":"70450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2971,"maximum":2971,"gross_charge":3714,"discounted_cash":3714,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2971},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2971},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2971}]}]},{"description":"Depuy Synthes 1.3mm Straight Plate","code_information":[{"code":"2800173","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2956,"maximum":2956,"gross_charge":3695,"discounted_cash":3695,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2956},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2956},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2956}]}]},{"description":"Evicel","code_information":[{"code":"3000092","type":"CDM"},{"code":"636","type":"RC"},{"code":"63713039055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2954,"maximum":2954,"gross_charge":3693,"discounted_cash":3693,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2954},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2954},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2954}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Closed Tx Nasal Bone Fract W/o Stabiliz","code_information":[{"code":"1000051","type":"CDM"},{"code":"450","type":"RC"},{"code":"21315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2952,"gross_charge":3690,"discounted_cash":3690,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2952},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2952},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2952}]}]},{"description":"Depuy Synthes 2.0 Mm Ti Lc-dcp Plate 4ho","code_information":[{"code":"2800177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2952,"maximum":2952,"gross_charge":3690,"discounted_cash":3690,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2952},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2952},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2952}]}]},{"description":"Intmd Rpr N-hf/genit2.6-7.6","code_information":[{"code":"1000238","type":"CDM"},{"code":"450","type":"RC"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2951,"gross_charge":3689,"discounted_cash":3689,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2951},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2951},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2951}]}]},{"description":"Acumed 22mm Acutrale Mini Screw","code_information":[{"code":"2800034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2944,"maximum":2944,"gross_charge":3680,"discounted_cash":3680,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2944},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2944},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2944}]}]},{"description":"Emer Dept High Severity&threat Funcj","code_information":[{"code":"8400424","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2938,"maximum":2938,"gross_charge":3672,"discounted_cash":3672,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2938}]}]},{"description":"Accutrak Standard Screw 24","code_information":[{"code":"2800020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2936,"maximum":2936,"gross_charge":3670,"discounted_cash":3670,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2936}]}]},{"description":"Drainage Lymph Node Abscess Simple","code_information":[{"code":"1000099","type":"CDM"},{"code":"450","type":"RC"},{"code":"38300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2930,"gross_charge":3662,"discounted_cash":3662,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2930},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2930},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2930}]}]},{"description":"Drainage Of Gum Lesion","code_information":[{"code":"1000096","type":"CDM"},{"code":"450","type":"RC"},{"code":"41800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2929,"gross_charge":3661,"discounted_cash":3661,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2929},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2929},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2929}]}]},{"description":"Insersect Propel Mini Sinus Stent","code_information":[{"code":"2800234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2920,"maximum":2920,"gross_charge":3650,"discounted_cash":3650,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2920},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2920},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2920}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"1000211","type":"CDM"},{"code":"450","type":"RC"},{"code":"65235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2919,"gross_charge":3649,"discounted_cash":3649,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2919},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2919},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2919}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"8400338","type":"CDM"},{"code":"450","type":"RC"},{"code":"65235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2919,"gross_charge":3649,"discounted_cash":3649,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2919},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2919},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2919}]}]},{"description":"Ct Thorax With Contrast Material(s)","code_information":[{"code":"8400036","type":"CDM"},{"code":"359","type":"RC"},{"code":"71260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2909,"maximum":2909,"gross_charge":3636,"discounted_cash":3636,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2909}]}]},{"description":"Er Visit Level 5","code_information":[{"code":"1000286","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":2908,"maximum":2908,"gross_charge":3635,"discounted_cash":3635,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2908},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2908},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2908}]}]},{"description":"Ct Upper Extremity With Contrast","code_information":[{"code":"8400052","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2906,"maximum":2906,"gross_charge":3633,"discounted_cash":3633,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2906},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2906},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2906}]}]},{"description":"Doppler In Addition To Echo Imaging Comp","code_information":[{"code":"5100003","type":"CDM"},{"code":"483","type":"RC"},{"code":"93320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":2887,"gross_charge":3609,"discounted_cash":3609,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2887},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2887},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2887},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Closure Of Split Wound","code_information":[{"code":"1000281","type":"CDM"},{"code":"450","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2882,"gross_charge":3603,"discounted_cash":3603,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2882},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2882},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2882}]}]},{"description":"Intro & Removal Proc On The Lungs&pleura","code_information":[{"code":"8400269","type":"CDM"},{"code":"450","type":"RC"},{"code":"32556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2864,"gross_charge":3580,"discounted_cash":3580,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2864}]}]},{"description":"Treat Fracture Radius & Ulna","code_information":[{"code":"1000059","type":"CDM"},{"code":"450","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2860,"gross_charge":3575,"discounted_cash":3575,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2860}]}]},{"description":"Repair Tongue Laceration","code_information":[{"code":"1000245","type":"CDM"},{"code":"450","type":"RC"},{"code":"41250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2850,"gross_charge":3562,"discounted_cash":3562,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2850}]}]},{"description":"Treat Finger Dislocation","code_information":[{"code":"1000037","type":"CDM"},{"code":"450","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2833,"maximum":2833,"gross_charge":3541,"discounted_cash":3541,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2833},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2833},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2833}]}]},{"description":"Ct Head Or Brain W/contrast Material(s)","code_information":[{"code":"8400022","type":"CDM"},{"code":"359","type":"RC"},{"code":"70460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2832,"maximum":2832,"gross_charge":3540,"discounted_cash":3540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2832},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2832},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2832}]}]},{"description":"Remove Foreign Body","code_information":[{"code":"1000155","type":"CDM"},{"code":"450","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2825,"gross_charge":3531,"discounted_cash":3531,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2825},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2825}]}]},{"description":"Blepharotomy Drainage Abscess Eyelid","code_information":[{"code":"1000010","type":"CDM"},{"code":"450","type":"RC"},{"code":"67700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2813,"gross_charge":3516,"discounted_cash":3516,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2813},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2813},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2813}]}]},{"description":"Depuy 9 Hole 3.5mm Lcp Plate","code_information":[{"code":"2800166","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2812,"maximum":2812,"gross_charge":3515,"discounted_cash":3515,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2812},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2812},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2812}]}]},{"description":"I&d Pilonidal Cyst Complicated","code_information":[{"code":"1000149","type":"CDM"},{"code":"450","type":"RC"},{"code":"10081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2803,"gross_charge":3504,"discounted_cash":3504,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2803},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2803},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2803}]}]},{"description":"Upr/lxtr Art Stdy 3+ Lvls","code_information":[{"code":"5100018","type":"CDM"},{"code":"921","type":"RC"},{"code":"93923","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":2802,"gross_charge":3502,"discounted_cash":3502,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2802},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2802},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2802},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Introduction Of Catheter, Superior Or In","code_information":[{"code":"2802367","type":"CDM"},{"code":"360","type":"RC"},{"code":"36010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2800,"gross_charge":3500,"discounted_cash":3500,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2800}]}]},{"description":"Cc E/m Critically Ill/injured 1st 30-74m","code_information":[{"code":"8400425","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2800,"gross_charge":3500,"discounted_cash":3500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2800},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Synthes Dhe Lag Screw 70mm","code_information":[{"code":"2800626","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2776,"maximum":2776,"gross_charge":3470,"discounted_cash":3470,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2776},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2776},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2776}]}]},{"description":"Colonoscopy Flex W/endosc Mucosal Resect","code_information":[{"code":"2200554","type":"CDM"},{"code":"750","type":"RC"},{"code":"45390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2771,"gross_charge":3464,"discounted_cash":3464,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2771},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2771},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2771}]}]},{"description":"Fixation Plate Medium 2hole 6mm","code_information":[{"code":"2800213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2770,"maximum":2770,"gross_charge":3463,"discounted_cash":3463,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2770}]}]},{"description":"Monet 2hole Fixation Hole","code_information":[{"code":"2800315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2770,"maximum":2770,"gross_charge":3463,"discounted_cash":3463,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2770}]}]},{"description":"Monet Ti Med 8 Dep 7mm","code_information":[{"code":"2800324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2770,"maximum":2770,"gross_charge":3463,"discounted_cash":3463,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2770}]}]},{"description":"Monet Titanium Cage Medium 6mm","code_information":[{"code":"2800325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2770,"maximum":2770,"gross_charge":3463,"discounted_cash":3463,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2770}]}]},{"description":"Monet Titanium Cage Medium 7mm","code_information":[{"code":"2800326","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2770,"maximum":2770,"gross_charge":3463,"discounted_cash":3463,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2770}]}]},{"description":"Ct Angiography Pelvis W/wo Contrast","code_information":[{"code":"8400047","type":"CDM"},{"code":"359","type":"RC"},{"code":"72191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2757,"maximum":2757,"gross_charge":3446,"discounted_cash":3446,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2757}]}]},{"description":"Drainage Finger Abscess Simp","code_information":[{"code":"1000098","type":"CDM"},{"code":"450","type":"RC"},{"code":"26010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2748,"maximum":2748,"gross_charge":3435,"discounted_cash":3435,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2748},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2748},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2748}]}]},{"description":"Mri Angio Chest W Or W/o Dye","code_information":[{"code":"5300047","type":"CDM"},{"code":"614","type":"RC"},{"code":"71555","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2745,"maximum":2745,"gross_charge":3431,"discounted_cash":3431,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2745},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2745},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2745}]}]},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"2202938","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2714,"gross_charge":3393,"discounted_cash":3393,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2714},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2714},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2714}]}]},{"description":"Cine/video Xrs","code_information":[{"code":"5000042","type":"CDM"},{"code":"320","type":"RC"},{"code":"76120","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2712,"maximum":2712,"gross_charge":3390,"discounted_cash":3390,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2712}]}]},{"description":"Speech Evaluation Complex","code_information":[{"code":"5000045","type":"CDM"},{"code":"329","type":"RC"},{"code":"70371","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2712,"maximum":2712,"gross_charge":3390,"discounted_cash":3390,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2712}]}]},{"description":"Unlisted Fluoroscopic Proc Diag Interven","code_information":[{"code":"5000189","type":"CDM"},{"code":"320","type":"RC"},{"code":"76946","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2712,"maximum":2712,"gross_charge":3390,"discounted_cash":3390,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2712}]}]},{"description":"Xr Osseous Survey Complete","code_information":[{"code":"5000240","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2712,"maximum":2712,"gross_charge":3390,"discounted_cash":3390,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2712}]}]},{"description":"Xr Osseous Survey Complete","code_information":[{"code":"5000302","type":"CDM"},{"code":"360","type":"RC"},{"code":"77075","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2712,"maximum":2712,"gross_charge":3390,"discounted_cash":3390,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2712}]}]},{"description":"45mm Xpress Continous Radius Rod","code_information":[{"code":"2800017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2700,"maximum":2700,"gross_charge":3375,"discounted_cash":3375,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2700}]}]},{"description":"Carpectomy All Bones Proximal Row","code_information":[{"code":"4200002","type":"CDM"},{"code":"730","type":"RC"},{"code":"92960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":2695,"gross_charge":3369,"discounted_cash":3369,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2695},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2695},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2695},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Control Of Nosebleed","code_information":[{"code":"1000080","type":"CDM"},{"code":"450","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2694,"gross_charge":3367,"discounted_cash":3367,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2694}]}]},{"description":"Treat Radius Fracture","code_information":[{"code":"1000061","type":"CDM"},{"code":"450","type":"RC"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2691,"gross_charge":3364,"discounted_cash":3364,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2691}]}]},{"description":"Ct Thorax Without Contrast Material","code_information":[{"code":"8400035","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2684,"maximum":2684,"gross_charge":3355,"discounted_cash":3355,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2684},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2684},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2684}]}]},{"description":"Removal Foreign Body Foot Subq","code_information":[{"code":"1000208","type":"CDM"},{"code":"450","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2682,"gross_charge":3353,"discounted_cash":3353,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2682},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2682},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2682}]}]},{"description":"Ct Upper Extr Wo","code_information":[{"code":"5200043","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":2675,"maximum":2675,"gross_charge":3344,"discounted_cash":3344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2675},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2675},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2675}]}]},{"description":"Ct Upper Extremity Wo/contrast","code_information":[{"code":"8400051","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2675,"maximum":2675,"gross_charge":3344,"discounted_cash":3344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2675},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2675},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2675}]}]},{"description":"Ct Lower Extremity Without Contrast","code_information":[{"code":"8400054","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2673,"maximum":2673,"gross_charge":3341,"discounted_cash":3341,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2673}]}]},{"description":"Ct Head Or Brain W/wo Contrast Material","code_information":[{"code":"8400023","type":"CDM"},{"code":"359","type":"RC"},{"code":"70470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2655,"maximum":2655,"gross_charge":3319,"discounted_cash":3319,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2655}]}]},{"description":"Intmd Rpr Face/mm 2.5 Cm/<","code_information":[{"code":"1000249","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2652,"gross_charge":3315,"discounted_cash":3315,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2652},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2652},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2652}]}]},{"description":"Mech Rem Obstr Mater Central Venous Dev","code_information":[{"code":"5000111","type":"CDM"},{"code":"320","type":"RC"},{"code":"75901","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2648,"maximum":2648,"gross_charge":3310,"discounted_cash":3310,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2648},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2648},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2648}]}]},{"description":"Ct Abdomen With Contrast Material(s)","code_information":[{"code":"8400059","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2636,"maximum":2636,"gross_charge":3295,"discounted_cash":3295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2636}]}]},{"description":"Drainage Of Scrotum","code_information":[{"code":"1000146","type":"CDM"},{"code":"450","type":"RC"},{"code":"54700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2631,"gross_charge":3289,"discounted_cash":3289,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2631},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2631},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2631}]}]},{"description":"Incision & Drainage Of Scrotal Abscess","code_information":[{"code":"8400309","type":"CDM"},{"code":"450","type":"RC"},{"code":"54700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2631,"gross_charge":3289,"discounted_cash":3289,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2631},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2631},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2631}]}]},{"description":"Synthes Mini Frag Locking Plate","code_information":[{"code":"2800640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2624,"maximum":2624,"gross_charge":3280,"discounted_cash":3280,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2624},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2624},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2624}]}]},{"description":"Removal Foreign Body Mouth","code_information":[{"code":"1000200","type":"CDM"},{"code":"450","type":"RC"},{"code":"40805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2620,"gross_charge":3275,"discounted_cash":3275,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2620},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2620},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2620}]}]},{"description":"Acumed 34mm Standard Screw","code_information":[{"code":"2800040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2612,"maximum":2612,"gross_charge":3265,"discounted_cash":3265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2612},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2612},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2612}]}]},{"description":"Insj Picc Rs&i 5 Yr+","code_information":[{"code":"1000177","type":"CDM"},{"code":"450","type":"RC"},{"code":"36573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":2610,"gross_charge":3262,"discounted_cash":3262,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2610},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2610},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2610},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Genspine Zv Pro 5.00 Cc","code_information":[{"code":"2800222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2600,"maximum":2600,"gross_charge":3250,"discounted_cash":3250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2600}]}]},{"description":"H100 Dbm Crush Mix","code_information":[{"code":"2800226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2600,"maximum":2600,"gross_charge":3250,"discounted_cash":3250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2600}]}]},{"description":"Providence Ally Bone Screw","code_information":[{"code":"2800363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2600,"maximum":2600,"gross_charge":3250,"discounted_cash":3250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2600}]}]},{"description":"Tl Medical 3.5 X 12mm Screw","code_information":[{"code":"2800673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2600,"maximum":2600,"gross_charge":3250,"discounted_cash":3250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2600}]}]},{"description":"Ventris Ostecyte Product","code_information":[{"code":"2800691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2600,"maximum":2600,"gross_charge":3250,"discounted_cash":3250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2600}]}]},{"description":"Closed Tx Calcaneal Fracture W/o Manip","code_information":[{"code":"1000015","type":"CDM"},{"code":"450","type":"RC"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2594,"gross_charge":3242,"discounted_cash":3242,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2594}]}]},{"description":"Bone And/or Joint Imaging Whole Body","code_information":[{"code":"5000030","type":"CDM"},{"code":"340","type":"RC"},{"code":"78306","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2588,"maximum":2588,"gross_charge":3235,"discounted_cash":3235,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2588}]}]},{"description":"Us Spinal Canal And Contents","code_information":[{"code":"5100059","type":"CDM"},{"code":"402","type":"RC"},{"code":"76800","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2578,"maximum":2578,"gross_charge":3223,"discounted_cash":3223,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2578}]}]},{"description":"Xr Gastrointestinal Tract","code_information":[{"code":"5000146","type":"CDM"},{"code":"329","type":"RC"},{"code":"74249","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2567,"maximum":2567,"gross_charge":3209,"discounted_cash":3209,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2567},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2567},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2567}]}]},{"description":"Enema Contrast For Reduc Intussusception","code_information":[{"code":"5000164","type":"CDM"},{"code":"329","type":"RC"},{"code":"74283","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2567,"maximum":2567,"gross_charge":3209,"discounted_cash":3209,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2567},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2567},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2567}]}]},{"description":"Mri Thoracic Spine Wo","code_information":[{"code":"5300038","type":"CDM"},{"code":"614","type":"RC"},{"code":"72146","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2567,"maximum":2567,"gross_charge":3209,"discounted_cash":3209,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2567},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2567},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2567}]}]},{"description":"Acumed Place .8mm 10hole","code_information":[{"code":"2800053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2556,"maximum":2556,"gross_charge":3195,"discounted_cash":3195,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2556},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2556},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2556}]}]},{"description":"Combined Endoscopic Catheterization","code_information":[{"code":"5000044","type":"CDM"},{"code":"329","type":"RC"},{"code":"74330","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2550,"maximum":2550,"gross_charge":3187,"discounted_cash":3187,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2550},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2550},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2550}]}]},{"description":"Rad Guidance For Perc Drainage","code_information":[{"code":"5000148","type":"CDM"},{"code":"320","type":"RC"},{"code":"75989","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2546,"maximum":2546,"gross_charge":3183,"discounted_cash":3183,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2546},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2546},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2546}]}]},{"description":"Myelography Thoracic Rad Sup&int","code_information":[{"code":"5000117","type":"CDM"},{"code":"614","type":"RC"},{"code":"72255","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2545,"maximum":2545,"gross_charge":3181,"discounted_cash":3181,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2545},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2545},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2545}]}]},{"description":"Xr Myelography Thoracic Rad Sup&int","code_information":[{"code":"8401470","type":"CDM"},{"code":"614","type":"RC"},{"code":"72255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2545,"maximum":2545,"gross_charge":3181,"discounted_cash":3181,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2545},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2545},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2545}]}]},{"description":"Removal Embedded Foreign Body Eyelid","code_information":[{"code":"1000199","type":"CDM"},{"code":"450","type":"RC"},{"code":"67938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2541,"gross_charge":3176,"discounted_cash":3176,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2541},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2541},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2541}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"2200559","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2539,"gross_charge":3174,"discounted_cash":3174,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2539}]}]},{"description":"Diagnostic Sigmoidoscopy","code_information":[{"code":"2202655","type":"CDM"},{"code":"750","type":"RC"},{"code":"45330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2539,"gross_charge":3174,"discounted_cash":3174,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2539}]}]},{"description":"Colorectal Scrn; Hi Risk Ind","code_information":[{"code":"2300001","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2539,"gross_charge":3174,"discounted_cash":3174,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2539}]}]},{"description":"Colon Ca Scrn Not Hi Rsk Ind","code_information":[{"code":"2300002","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2539,"gross_charge":3174,"discounted_cash":3174,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2539}]}]},{"description":"Insj Picc 5 Yr+ W/o Imaging","code_information":[{"code":"1000176","type":"CDM"},{"code":"450","type":"RC"},{"code":"36569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":2536,"gross_charge":3170,"discounted_cash":3170,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2536},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2536},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2536},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Insj Picc 5 Yr+ W/o Imaging","code_information":[{"code":"2201562","type":"CDM"},{"code":"940","type":"RC"},{"code":"36569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":2536,"gross_charge":3170,"discounted_cash":3170,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2536},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2536},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2536},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Largsc W/rmvl Foreign Bdy(s)","code_information":[{"code":"1000183","type":"CDM"},{"code":"450","type":"RC"},{"code":"31577","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2534,"gross_charge":3167,"discounted_cash":3167,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2534}]}]},{"description":"New Or Level 2 Addl 15 Mins","code_information":[{"code":"12202987","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202987","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2526,"maximum":2526,"gross_charge":3158,"discounted_cash":3158,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2526}]}]},{"description":"Set Radiation Therapy Field","code_information":[{"code":"5000166","type":"CDM"},{"code":"329","type":"RC"},{"code":"77290","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2518,"maximum":2518,"gross_charge":3147,"discounted_cash":3147,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2518},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2518},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2518}]}]},{"description":"Ophth Us B W/non-quant A","code_information":[{"code":"5100022","type":"CDM"},{"code":"402","type":"RC"},{"code":"76512","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2513,"maximum":2513,"gross_charge":3141,"discounted_cash":3141,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2513},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2513},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2513}]}]},{"description":"Gore Bio-a Tissue Reinforcement Mesh","code_information":[{"code":"2800223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2484,"maximum":2484,"gross_charge":3105,"discounted_cash":3105,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2484}]}]},{"description":"Intmd Rpr N-hf/genit 2.5cm/<","code_information":[{"code":"1000237","type":"CDM"},{"code":"450","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2482,"gross_charge":3102,"discounted_cash":3102,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2482},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2482},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2482}]}]},{"description":"Bard Mesh Plug Large","code_information":[{"code":"2800122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2474,"maximum":2474,"gross_charge":3092,"discounted_cash":3092,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2474}]}]},{"description":"Remove Nasal Foreign Body","code_information":[{"code":"1000196","type":"CDM"},{"code":"450","type":"RC"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2470,"maximum":2470,"gross_charge":3088,"discounted_cash":3088,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2470}]}]},{"description":"Ct Soft Tissue Neck W/wo Contrast","code_information":[{"code":"8400032","type":"CDM"},{"code":"359","type":"RC"},{"code":"70492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2466,"maximum":2466,"gross_charge":3082,"discounted_cash":3082,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2466},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2466},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2466}]}]},{"description":"Xtant Osteoselect Dbm Putty 5.0cc","code_information":[{"code":"2800712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2465,"maximum":2465,"gross_charge":3081,"discounted_cash":3081,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2465},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2465},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2465}]}]},{"description":"Anoscopy With Removal Foreign Body","code_information":[{"code":"1000107","type":"CDM"},{"code":"450","type":"RC"},{"code":"46608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2458,"gross_charge":3073,"discounted_cash":3073,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2458},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2458},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2458}]}]},{"description":"Medtronic Bone Putty","code_information":[{"code":"2800287","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2448,"maximum":2448,"gross_charge":3060,"discounted_cash":3060,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2448},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2448},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2448}]}]},{"description":"Intmd Rpr S/a/t/ext 2.5 Cm/<","code_information":[{"code":"1000241","type":"CDM"},{"code":"450","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2444,"gross_charge":3055,"discounted_cash":3055,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2444},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2444},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2444}]}]},{"description":"Leuprolide Acetate /3.75 Mg","code_information":[{"code":"8400918","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2442,"maximum":2442,"gross_charge":3052,"discounted_cash":3052,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2442}]}]},{"description":"Ct Lower Extremity W/wo Contrast","code_information":[{"code":"8400056","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2442,"maximum":2442,"gross_charge":3052,"discounted_cash":3052,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2442}]}]},{"description":"Us Arterial Dop Low Ext Unilat","code_information":[{"code":"5100011","type":"CDM"},{"code":"402","type":"RC"},{"code":"93926","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2440,"maximum":2440,"gross_charge":3050,"discounted_cash":3050,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2440}]}]},{"description":"Closed Tx Talus Fract W/o Manip","code_information":[{"code":"1000070","type":"CDM"},{"code":"450","type":"RC"},{"code":"28430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2437,"gross_charge":3046,"discounted_cash":3046,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2437}]}]},{"description":"Emer Dept Hi Severity&urgent Eval","code_information":[{"code":"8400423","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2436,"maximum":2436,"gross_charge":3045,"discounted_cash":3045,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2436},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2436},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2436}]}]},{"description":"Synthes  Lcp Plate 6 Hole","code_information":[{"code":"2800554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2428,"maximum":2428,"gross_charge":3035,"discounted_cash":3035,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2428},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2428},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2428}]}]},{"description":"Synthes 3.5mm Lcp 8 Hole Place","code_information":[{"code":"2800603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2428,"maximum":2428,"gross_charge":3035,"discounted_cash":3035,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2428},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2428},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2428}]}]},{"description":"Acumed 3.5mm Acutrak 4.7screw","code_information":[{"code":"2800037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2424,"maximum":2424,"gross_charge":3030,"discounted_cash":3030,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2424},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2424},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2424}]}]},{"description":"Ct Soft Tissue Neck With Contrast","code_information":[{"code":"8400031","type":"CDM"},{"code":"359","type":"RC"},{"code":"70491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2415,"maximum":2415,"gross_charge":3019,"discounted_cash":3019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2415},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2415},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2415}]}]},{"description":"Insert Non-tunnel Cv Cath","code_information":[{"code":"1000175","type":"CDM"},{"code":"450","type":"RC"},{"code":"36556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2411,"gross_charge":3014,"discounted_cash":3014,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2411},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2411},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2411}]}]},{"description":"Repair Nail Bed","code_information":[{"code":"1000248","type":"CDM"},{"code":"450","type":"RC"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2407,"gross_charge":3009,"discounted_cash":3009,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2407},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2407},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2407}]}]},{"description":"Cc E/m Critically Ill/injured Ea 30 Min","code_information":[{"code":"8400426","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2400,"maximum":2400,"gross_charge":3000,"discounted_cash":3000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2400}]}]},{"description":"Cmd Self Pay","code_information":[{"code":"8400443","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"004","type":"DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2400,"maximum":2400,"gross_charge":3000,"discounted_cash":3000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2400}]}]},{"description":"Cmd Self Pay","code_information":[{"code":"8500443","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"004","type":"DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2400,"maximum":2400,"gross_charge":3000,"discounted_cash":3000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2400}]}]},{"description":"Closed Tx Scapular Fract W/o Manip","code_information":[{"code":"1000065","type":"CDM"},{"code":"450","type":"RC"},{"code":"23570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2370,"gross_charge":2962,"discounted_cash":2962,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2370}]}]},{"description":"Extracranial Study","code_information":[{"code":"5100007","type":"CDM"},{"code":"320","type":"RC"},{"code":"93882","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2366,"maximum":2366,"gross_charge":2957,"discounted_cash":2957,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2366}]}]},{"description":"Xr Hip Bilat 5+ Views","code_information":[{"code":"5000225","type":"CDM"},{"code":"329","type":"RC"},{"code":"73523","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2351,"maximum":2351,"gross_charge":2939,"discounted_cash":2939,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2351},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2351},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2351}]}]},{"description":"Xr Hips Bilateral W/pelvis Min 5 Vw","code_information":[{"code":"8401495","type":"CDM"},{"code":"329","type":"RC"},{"code":"73523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2351,"maximum":2351,"gross_charge":2939,"discounted_cash":2939,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2351},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2351},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2351}]}]},{"description":"Ct Orbit Slla/pst Fss/ot Mid/in Ear Wo/c","code_information":[{"code":"8400024","type":"CDM"},{"code":"350","type":"RC"},{"code":"70480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2336,"maximum":2336,"gross_charge":2920,"discounted_cash":2920,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2336}]}]},{"description":"Infect Agent Ant Resp Syncytial Virus","code_information":[{"code":"4000271","type":"CDM"},{"code":"300","type":"RC"},{"code":"87807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2317,"maximum":2317,"gross_charge":2896,"discounted_cash":2896,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2317},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2317},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2317}]}]},{"description":"Botox Onabotulinumtoxina 100u","code_information":[{"code":"3000034","type":"CDM"},{"code":"636","type":"RC"},{"code":"23114","type":"CPT","modifier":"501"}],"standard_charges":[{"setting":"outpatient","modifier_code":["501"],"minimum":2316,"maximum":2316,"gross_charge":2895,"discounted_cash":2895,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2316}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Removal Foreign Body Mouth","code_information":[{"code":"1000201","type":"CDM"},{"code":"450","type":"RC"},{"code":"40804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2303,"maximum":2303,"gross_charge":2879,"discounted_cash":2879,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2303},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2303},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2303}]}]},{"description":"Picasso 5.5mm X40mm","code_information":[{"code":"2800350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2300,"gross_charge":2875,"discounted_cash":2875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2300}]}]},{"description":"Picasso Ii 5.5x50 Mis Screw","code_information":[{"code":"2800351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2300,"gross_charge":2875,"discounted_cash":2875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2300}]}]},{"description":"Picasso Ii 6.5 X 50mm Mis Screw","code_information":[{"code":"2800353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2300,"gross_charge":2875,"discounted_cash":2875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2300}]}]},{"description":"Picasso Ii 6.5x45 Mis Screw","code_information":[{"code":"2800354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2300,"gross_charge":2875,"discounted_cash":2875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2300}]}]},{"description":"Picasso Ii 6.5x45mm Polyaxial Screw","code_information":[{"code":"2800355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2300,"gross_charge":2875,"discounted_cash":2875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2300}]}]},{"description":"Picasso Ii Mis Screw5.5 X 35mm","code_information":[{"code":"2800358","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2300,"gross_charge":2875,"discounted_cash":2875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2300}]}]},{"description":"Tl Amedica Picasso Ii Perc Polyaxial 127","code_information":[{"code":"2800671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2300,"gross_charge":2875,"discounted_cash":2875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2300}]}]},{"description":"Tl Medical 6.5 X 40mm Screw","code_information":[{"code":"2800675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2300,"maximum":2300,"gross_charge":2875,"discounted_cash":2875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2300}]}]},{"description":"Echo Exam Of Head","code_information":[{"code":"5000074","type":"CDM"},{"code":"320","type":"RC"},{"code":"76506","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Fetal Biophys Profile W/nst","code_information":[{"code":"5000078","type":"CDM"},{"code":"402","type":"RC"},{"code":"76818","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Fetal Biophys Profil W/o Nst","code_information":[{"code":"5000079","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Opth Ultrasonic Foreign Bdy Localization","code_information":[{"code":"5000121","type":"CDM"},{"code":"402","type":"RC"},{"code":"76529","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Arterial Dop Low Ext Bilat","code_information":[{"code":"5100010","type":"CDM"},{"code":"402","type":"RC"},{"code":"93925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Ophth Us Quant A Only","code_information":[{"code":"5100024","type":"CDM"},{"code":"402","type":"RC"},{"code":"76511","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Breast Complete","code_information":[{"code":"5100026","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Ultrasound of abdomen","code_information":[{"code":"5100034","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Soft Tissue Thorax","code_information":[{"code":"5100037","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Ob Detailed Sngl Fetus","code_information":[{"code":"5100045","type":"CDM"},{"code":"402","type":"RC"},{"code":"76811","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Abdomial ultrasound of pregnant uterus","code_information":[{"code":"5100047","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Ob < 14 Wks Single Fetus","code_information":[{"code":"5100049","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Preg Uterus Real Time/additionl Gest","code_information":[{"code":"5100050","type":"CDM"},{"code":"402","type":"RC"},{"code":"76814","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Ob Fetal 1st Trimester","code_information":[{"code":"5100051","type":"CDM"},{"code":"402","type":"RC"},{"code":"76813","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Preg Uterus Real Time/re-eval Abnorm","code_information":[{"code":"5100052","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Pregnant Uterus Transvag Real Time","code_information":[{"code":"5100054","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Retroperitoneal Complete","code_information":[{"code":"5100055","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Soft Tissue Head/neck","code_information":[{"code":"5100058","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Kidney Transplant, Doppler Real Time","code_information":[{"code":"5100060","type":"CDM"},{"code":"402","type":"RC"},{"code":"76776","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Prostate","code_information":[{"code":"5100061","type":"CDM"},{"code":"402","type":"RC"},{"code":"76872","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Us Arterial Dop Upper Ext Unilat Lt","code_information":[{"code":"5100065","type":"CDM"},{"code":"402","type":"RC"},{"code":"93931","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":2293,"maximum":2293,"gross_charge":2866,"discounted_cash":2866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2293}]}]},{"description":"Arthrex Suture Anchor Bio-comp Pushlock","code_information":[{"code":"2800094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2288,"maximum":2288,"gross_charge":2860,"discounted_cash":2860,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2288}]}]},{"description":"Closed Tx Metatarsal Fract W/o Manip Ea","code_information":[{"code":"1000048","type":"CDM"},{"code":"450","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2283,"gross_charge":2854,"discounted_cash":2854,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2283}]}]},{"description":"Inj Shoulder Arthropathy Imaging Only","code_information":[{"code":"2201439","type":"CDM"},{"code":"320","type":"RC"},{"code":"23350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2277,"gross_charge":2846,"discounted_cash":2846,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2277},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2277},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2277}]}]},{"description":"Removal Of Nail Bed","code_information":[{"code":"1000133","type":"CDM"},{"code":"450","type":"RC"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2270,"gross_charge":2838,"discounted_cash":2838,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2270}]}]},{"description":"Nm Gastric Emptying","code_information":[{"code":"5000085","type":"CDM"},{"code":"329","type":"RC"},{"code":"78264","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2269,"maximum":2269,"gross_charge":2836,"discounted_cash":2836,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2269},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2269},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2269}]}]},{"description":"Acumed 45 Acutrack 4.7 Screw","code_information":[{"code":"2800042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2264,"maximum":2264,"gross_charge":2830,"discounted_cash":2830,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"Davol Ventralight St Echo 4x6'mesh","code_information":[{"code":"2800153","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2258,"maximum":2258,"gross_charge":2823,"discounted_cash":2823,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2258}]}]},{"description":"Drainage Mouth Lesion","code_information":[{"code":"1000100","type":"CDM"},{"code":"450","type":"RC"},{"code":"40800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2248,"maximum":2248,"gross_charge":2810,"discounted_cash":2810,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2248}]}]},{"description":"Closed Tx Clavicular Fract W/o Manip","code_information":[{"code":"1000021","type":"CDM"},{"code":"450","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2244,"gross_charge":2805,"discounted_cash":2805,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2244},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2244},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2244}]}]},{"description":"Drainage Ext Ear Abscess/hematoma Comp","code_information":[{"code":"1000094","type":"CDM"},{"code":"450","type":"RC"},{"code":"69005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2241,"gross_charge":2801,"discounted_cash":2801,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2241}]}]},{"description":"Accutrac 30mm Screw","code_information":[{"code":"2800019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2240,"maximum":2240,"gross_charge":2800,"discounted_cash":2800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2240}]}]},{"description":"Acumed 30mm Acutrak Standard Screw","code_information":[{"code":"2800039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2240,"maximum":2240,"gross_charge":2800,"discounted_cash":2800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2240}]}]},{"description":"Acutrac 28mm Standard Screw","code_information":[{"code":"2800055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2240,"maximum":2240,"gross_charge":2800,"discounted_cash":2800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2240}]}]},{"description":"Shortlatency Somatsnsry Evoked Pot Study","code_information":[{"code":"2202654","type":"CDM"},{"code":"740","type":"RC"},{"code":"95938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2216,"maximum":2300,"gross_charge":2770,"discounted_cash":2770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"J&j 2.0 Mm Ti Elastic Nail 440mm","code_information":[{"code":"2800242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2212,"maximum":2212,"gross_charge":2765,"discounted_cash":2765,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2212}]}]},{"description":"Catheter, Thrombectomy/embolectomy","code_information":[{"code":"28000755","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2206,"maximum":2206,"gross_charge":2758,"discounted_cash":2758,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2206},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2206},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2206}]}]},{"description":"Cage Medium 6mm 8 Degrees","code_information":[{"code":"2800132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2200,"maximum":2200,"gross_charge":2750,"discounted_cash":2750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2200}]}]},{"description":"Fixation Plate Medium 2hole 7mm","code_information":[{"code":"2800214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2200,"maximum":2200,"gross_charge":2750,"discounted_cash":2750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2200}]}]},{"description":"Monet Fixation Plate Med 2-hole 7mm","code_information":[{"code":"2800319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2200,"maximum":2200,"gross_charge":2750,"discounted_cash":2750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2200}]}]},{"description":"Monet Medium 7mm Cage","code_information":[{"code":"2800322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2200,"maximum":2200,"gross_charge":2750,"discounted_cash":2750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2200}]}]},{"description":"Synthes 98mm Lcp Plate","code_information":[{"code":"2800762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2200,"maximum":2200,"gross_charge":2750,"discounted_cash":2750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2200}]}]},{"description":"Rabies Immune Globulin For Im Or Subq","code_information":[{"code":"2202266","type":"CDM"},{"code":"360","type":"RC"},{"code":"90375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2198,"maximum":2198,"gross_charge":2748,"discounted_cash":2748,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2198}]}]},{"description":"Mimedx Amniofix 4.0x10 Cm","code_information":[{"code":"2800739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2184,"maximum":2184,"gross_charge":2730,"discounted_cash":2730,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2184}]}]},{"description":"Rpr Fe/e/en/l/m 12.6-20.0 Cm","code_information":[{"code":"1000254","type":"CDM"},{"code":"450","type":"RC"},{"code":"12016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2182,"gross_charge":2728,"discounted_cash":2728,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2182}]}]},{"description":"Stryker Calcaneus Mesh Plate Large","code_information":[{"code":"2800476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2178,"maximum":2178,"gross_charge":2722,"discounted_cash":2722,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2178}]}]},{"description":"Stryker Calcaneus Plate","code_information":[{"code":"2800477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2178,"maximum":2178,"gross_charge":2722,"discounted_cash":2722,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2178}]}]},{"description":"New patient office or other outpatient visit, 60 min","code_information":[{"code":"6100071","type":"CDM"},{"code":"521","type":"RC"},{"code":"99205","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":2176,"maximum":2176,"gross_charge":2720,"discounted_cash":2720,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2176}]}]},{"description":"New patient office or other outpatient visit, 60 min","code_information":[{"code":"6100072","type":"CDM"},{"code":"521","type":"RC"},{"code":"99205","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":2176,"maximum":2176,"gross_charge":2720,"discounted_cash":2720,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2176}]}]},{"description":"Drainage Scrotal Wall Abcess","code_information":[{"code":"1000101","type":"CDM"},{"code":"450","type":"RC"},{"code":"55100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2176,"gross_charge":2720,"discounted_cash":2720,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2176}]}]},{"description":"Clsd Tx Carpal Scaphoid Fract Wo/manip","code_information":[{"code":"8400183","type":"CDM"},{"code":"450","type":"RC"},{"code":"25622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2170,"maximum":2170,"gross_charge":2712,"discounted_cash":2712,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2170}]}]},{"description":"Control Of Nosebleed","code_information":[{"code":"1000078","type":"CDM"},{"code":"450","type":"RC"},{"code":"30903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2166,"gross_charge":2707,"discounted_cash":2707,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2166}]}]},{"description":"Er Visit Level 4","code_information":[{"code":"1000287","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":2151,"maximum":2151,"gross_charge":2689,"discounted_cash":2689,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2151},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2151},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2151}]}]},{"description":"Depuy 4.5 Healix Anchor","code_information":[{"code":"2800164","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2148,"maximum":2148,"gross_charge":2685,"discounted_cash":2685,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2148}]}]},{"description":"Ct Soft Tissue Neck Without Contrast","code_information":[{"code":"8400030","type":"CDM"},{"code":"359","type":"RC"},{"code":"70490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2143,"maximum":2143,"gross_charge":2679,"discounted_cash":2679,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2143}]}]},{"description":"Us Guidance For Vascular Access","code_information":[{"code":"5100029","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2137,"maximum":2137,"gross_charge":2671,"discounted_cash":2671,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2137}]}]},{"description":"Sigmoidoscopy And Biopsy","code_information":[{"code":"2202656","type":"CDM"},{"code":"750","type":"RC"},{"code":"45331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2134,"gross_charge":2668,"discounted_cash":2668,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2134}]}]},{"description":"I&d Perianal Abscess Superficial","code_information":[{"code":"1000152","type":"CDM"},{"code":"450","type":"RC"},{"code":"46050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2130,"gross_charge":2663,"discounted_cash":2663,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2130}]}]},{"description":"Njx Sclrsnt Spider Veins","code_information":[{"code":"2202668","type":"CDM"},{"code":"330","type":"RC"},{"code":"36468","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":750,"maximum":2121,"gross_charge":2651,"discounted_cash":2651,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2121},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2121},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":750}]}]},{"description":"New Or Level 1 Addl 15 Mins","code_information":[{"code":"12202989","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP12202989","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2114,"maximum":2114,"gross_charge":2643,"discounted_cash":2643,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2114},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2114},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2114}]}]},{"description":"Bard Power Port 8f","code_information":[{"code":"2800125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2108,"maximum":2108,"gross_charge":2635,"discounted_cash":2635,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2108}]}]},{"description":"Removal Of Arm Foreign Body","code_information":[{"code":"1000212","type":"CDM"},{"code":"450","type":"RC"},{"code":"24200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2106,"maximum":2106,"gross_charge":2633,"discounted_cash":2633,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2106}]}]},{"description":"Spinal Puncture Drainage Of Csf","code_information":[{"code":"1000264","type":"CDM"},{"code":"450","type":"RC"},{"code":"62272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2102,"gross_charge":2627,"discounted_cash":2627,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2102}]}]},{"description":"Mimedx Amnio Fill 500mg (Charge 2 Units)","code_information":[{"code":"2800309","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2100,"maximum":2100,"gross_charge":2625,"discounted_cash":2625,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2100}]}]},{"description":"Clsd Tx Distal Rad Fract/epiphyseal Sep","code_information":[{"code":"8400182","type":"CDM"},{"code":"450","type":"RC"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":2090,"gross_charge":2613,"discounted_cash":2613,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2090},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2090},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2090}]}]},{"description":"Medartis 2x2 Hole, Trapezoid Plate","code_information":[{"code":"2800813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2086,"maximum":2086,"gross_charge":2607,"discounted_cash":2607,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2086},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2086},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2086}]}]},{"description":"J&j 1.5 Ti Elastic Nail 300mm","code_information":[{"code":"2800240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2084,"maximum":2084,"gross_charge":2605,"discounted_cash":2605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2084},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2084}]}]},{"description":"Synthes 1.5mm Lcp 6 Hole Plate","code_information":[{"code":"2800567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2076,"maximum":2076,"gross_charge":2595,"discounted_cash":2595,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2076},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2076},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2076}]}]},{"description":"Usg For Needle Placement","code_information":[{"code":"5000185","type":"CDM"},{"code":"320","type":"RC"},{"code":"76942","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2071,"maximum":2071,"gross_charge":2589,"discounted_cash":2589,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2071},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2071},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2071}]}]},{"description":"Xr Hip Unilat Ltd 1-2v Lt","code_information":[{"code":"5000222","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2058,"maximum":2058,"gross_charge":2572,"discounted_cash":2572,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2058}]}]},{"description":"Rpr S/n/a/gen/trk20.1-30.0cm","code_information":[{"code":"1000261","type":"CDM"},{"code":"450","type":"RC"},{"code":"12006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2050,"gross_charge":2563,"discounted_cash":2563,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2050},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2050},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2050}]}]},{"description":"Inj Anes Agent Intercostal Nerve Single","code_information":[{"code":"600007","type":"CDM"},{"code":"220","type":"RC"},{"code":"64420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2044,"gross_charge":2555,"discounted_cash":2555,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2044},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2044},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2044}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"1000055","type":"CDM"},{"code":"450","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2041,"gross_charge":2551,"discounted_cash":2551,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2041},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2041},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2041}]}]},{"description":"Us Pelvis Limited Soft Tissue","code_information":[{"code":"5100043","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2040,"maximum":2040,"gross_charge":2550,"discounted_cash":2550,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2040},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2040},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2040}]}]},{"description":"Chemodenervation Of Muscle(s); Muscle(s)","code_information":[{"code":"22100013","type":"CDM"},{"code":"360","type":"RC"},{"code":"64615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2032,"gross_charge":2540,"discounted_cash":2540,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2032}]}]},{"description":"Laryngoscopy W/fb Removal","code_information":[{"code":"1000182","type":"CDM"},{"code":"450","type":"RC"},{"code":"31530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2032,"gross_charge":2540,"discounted_cash":2540,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2032}]}]},{"description":"Laryngoscopy With Foreign Body Removal","code_information":[{"code":"8400264","type":"CDM"},{"code":"450","type":"RC"},{"code":"31530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":2032,"gross_charge":2540,"discounted_cash":2540,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2032}]}]},{"description":"J&j 5.0 Peripro Val Screw Slf Tpng Sd 12","code_information":[{"code":"2800247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2016,"maximum":2016,"gross_charge":2520,"discounted_cash":2520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2016}]}]},{"description":"Synthes 7.3mm Cannulated Screw 32mm","code_information":[{"code":"2800622","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2016,"maximum":2016,"gross_charge":2520,"discounted_cash":2520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2016}]}]},{"description":"Synthes 70mm Screw","code_information":[{"code":"2800623","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2016,"maximum":2016,"gross_charge":2520,"discounted_cash":2520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2016}]}]},{"description":"Radiation Treatment Aid(s)","code_information":[{"code":"5000176","type":"CDM"},{"code":"999","type":"RC"},{"code":"77334","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2014,"maximum":2014,"gross_charge":2518,"discounted_cash":2518,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2014}]}]},{"description":"Drainage Of Tonsil Abscess","code_information":[{"code":"1000142","type":"CDM"},{"code":"450","type":"RC"},{"code":"42700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2013,"gross_charge":2516,"discounted_cash":2516,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2013}]}]},{"description":"Usg Interstitial Rad","code_information":[{"code":"5000183","type":"CDM"},{"code":"402","type":"RC"},{"code":"76965","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2011,"maximum":2011,"gross_charge":2514,"discounted_cash":2514,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2011},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2011},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2011}]}]},{"description":"Perc Placement Enteroclysis Tube Rad","code_information":[{"code":"5000127","type":"CDM"},{"code":"329","type":"RC"},{"code":"74355","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2006,"maximum":2006,"gross_charge":2508,"discounted_cash":2508,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2006},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2006},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2006}]}]},{"description":"Insertion And Placement Of Flow Directed","code_information":[{"code":"2100162","type":"CDM"},{"code":"360","type":"RC"},{"code":"93503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":2000,"gross_charge":2500,"discounted_cash":2500,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2000}]}]},{"description":"Supply/accessory/service","code_information":[{"code":"2800001","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2000,"maximum":2000,"gross_charge":2500,"discounted_cash":2500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2000}]}]},{"description":"Cancelleous Crushed 10cc Bone Chips","code_information":[{"code":"2800133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2000,"maximum":2000,"gross_charge":2500,"discounted_cash":2500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2000}]}]},{"description":"Evolution Bone Putty","code_information":[{"code":"2800205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2000,"maximum":2000,"gross_charge":2500,"discounted_cash":2500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2000}]}]},{"description":"Zvpro Putty 2.5cc","code_information":[{"code":"2800738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2000,"maximum":2000,"gross_charge":2500,"discounted_cash":2500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2000}]}]},{"description":"30 Bone Chip","code_information":[{"code":"2800780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2000,"maximum":2000,"gross_charge":2500,"discounted_cash":2500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2000}]}]},{"description":"Eeg During Nonintracranial Carotid Surg","code_information":[{"code":"5600001","type":"CDM"},{"code":"740","type":"RC"},{"code":"95955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2000,"maximum":2300,"gross_charge":2500,"discounted_cash":2500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Surgical Techniques Requiring Use Of Rob","code_information":[{"code":"28000759","type":"CDM"},{"code":"360","type":"RC"},{"code":"S2900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2000,"maximum":2000,"gross_charge":2500,"discounted_cash":2500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2000}]}]},{"description":"Bone Age Studies","code_information":[{"code":"5000025","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1996,"maximum":1996,"gross_charge":2495,"discounted_cash":2495,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1996},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1996},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1996}]}]},{"description":"Sonohysterography Incl Colorflow Doppler","code_information":[{"code":"5000151","type":"CDM"},{"code":"402","type":"RC"},{"code":"76831","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1985,"maximum":1985,"gross_charge":2481,"discounted_cash":2481,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1985},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1985},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1985}]}]},{"description":"Arthrex Fiberstitch Implant Acl","code_information":[{"code":"2800083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1980,"maximum":1980,"gross_charge":2475,"discounted_cash":2475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1980}]}]},{"description":"Exc Benign Lsn Inc Trk/arm/leg 3.1-4.0cm","code_information":[{"code":"1000131","type":"CDM"},{"code":"450","type":"RC"},{"code":"11404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Drainage Of Hematoma/fluid","code_information":[{"code":"1000147","type":"CDM"},{"code":"450","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Incision&removal Fb Subq Tiss Comp","code_information":[{"code":"8400073","type":"CDM"},{"code":"450","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"I And D Hematoma Seroma Fluid Collection","code_information":[{"code":"8400074","type":"CDM"},{"code":"450","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Excision Benign Lesion Trunk Arms O","code_information":[{"code":"8400086","type":"CDM"},{"code":"450","type":"RC"},{"code":"11404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Removal Foreign Body Upper Arm Or Elbow","code_information":[{"code":"8400168","type":"CDM"},{"code":"450","type":"RC"},{"code":"24200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1978,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Drainage Of Finger Abscess","code_information":[{"code":"8400189","type":"CDM"},{"code":"450","type":"RC"},{"code":"26011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Removal Of Foot Foreign Body/deep","code_information":[{"code":"8400226","type":"CDM"},{"code":"450","type":"RC"},{"code":"28192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Removal Of Foreign Body Foot Complicated","code_information":[{"code":"8400227","type":"CDM"},{"code":"450","type":"RC"},{"code":"28193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Drain Lymph Node Absc/lymphadenitis Smpl","code_information":[{"code":"8400281","type":"CDM"},{"code":"450","type":"RC"},{"code":"38300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Drainage Of Scrotum Abscess","code_information":[{"code":"8400310","type":"CDM"},{"code":"450","type":"RC"},{"code":"55100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Drg Xtrnl Ear Absc/hmtma Comp","code_information":[{"code":"8400343","type":"CDM"},{"code":"450","type":"RC"},{"code":"69005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Rmvl Fb Xtrnl Aud Canal Anes","code_information":[{"code":"8400345","type":"CDM"},{"code":"450","type":"RC"},{"code":"69205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1978,"gross_charge":2473,"discounted_cash":2473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Stryker Headless Compression Screw 0.4mm","code_information":[{"code":"2800496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1978,"maximum":1978,"gross_charge":2472,"discounted_cash":2472,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1978}]}]},{"description":"Arthrex Tenodesis Screw Biocomposite","code_information":[{"code":"2800096","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1972,"maximum":1972,"gross_charge":2465,"discounted_cash":2465,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1972},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1972},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1972}]}]},{"description":"Drainage Ext Ear Abscess/hematoma Simple","code_information":[{"code":"1000095","type":"CDM"},{"code":"450","type":"RC"},{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1968,"gross_charge":2460,"discounted_cash":2460,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1968}]}]},{"description":"Repair Complex Area 5 Cm Or Less","code_information":[{"code":"1000223","type":"CDM"},{"code":"450","type":"RC"},{"code":"13153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1962,"gross_charge":2453,"discounted_cash":2453,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1962},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1962},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1962}]}]},{"description":"Remove Tendon Sheath Lesion","code_information":[{"code":"1000132","type":"CDM"},{"code":"450","type":"RC"},{"code":"26160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Treatment Of Rib Fracture","code_information":[{"code":"1000191","type":"CDM"},{"code":"450","type":"RC"},{"code":"21812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Incise Hand/finger Tendon","code_information":[{"code":"1000275","type":"CDM"},{"code":"450","type":"RC"},{"code":"26460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Open Treatment Of Rib Fracture W/int Fix","code_information":[{"code":"8400160","type":"CDM"},{"code":"450","type":"RC"},{"code":"21812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Treat Clavicle Fracture","code_information":[{"code":"8400162","type":"CDM"},{"code":"450","type":"RC"},{"code":"23505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Proximal Humeral Fract W/manip","code_information":[{"code":"8400165","type":"CDM"},{"code":"450","type":"RC"},{"code":"23605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Shldr Dislocation W/manip W/ans","code_information":[{"code":"8400167","type":"CDM"},{"code":"450","type":"RC"},{"code":"23655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Supra/transcondylar Humeral Frct","code_information":[{"code":"8400170","type":"CDM"},{"code":"450","type":"RC"},{"code":"24535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Radial Head/neck Fract W/manip","code_information":[{"code":"8400174","type":"CDM"},{"code":"450","type":"RC"},{"code":"24655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Ulnar Fract Proximal End W/m","code_information":[{"code":"8400176","type":"CDM"},{"code":"450","type":"RC"},{"code":"24675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Radial Shaft Fracture W/manip","code_information":[{"code":"8400177","type":"CDM"},{"code":"450","type":"RC"},{"code":"25505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Radial/ulnar Shaft Fract W/man","code_information":[{"code":"8400180","type":"CDM"},{"code":"450","type":"RC"},{"code":"25565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Carpal Bone Fract W/manip","code_information":[{"code":"8400185","type":"CDM"},{"code":"450","type":"RC"},{"code":"25635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Remove Tendon Sheath Lesion","code_information":[{"code":"8400190","type":"CDM"},{"code":"450","type":"RC"},{"code":"26160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Tenotomy Extensor Hand/fingr Open Ea Tdn","code_information":[{"code":"8400193","type":"CDM"},{"code":"450","type":"RC"},{"code":"26460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Mcp Disloc Sngl W/man Wo/anes","code_information":[{"code":"8400200","type":"CDM"},{"code":"450","type":"RC"},{"code":"26705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"8400203","type":"CDM"},{"code":"450","type":"RC"},{"code":"26742","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Femoral Shaft Fract W/manip","code_information":[{"code":"8400210","type":"CDM"},{"code":"450","type":"RC"},{"code":"27502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Tibial Shaft Fract W/manip Wi","code_information":[{"code":"8400215","type":"CDM"},{"code":"450","type":"RC"},{"code":"27752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Bimalleolar Ankle Fract","code_information":[{"code":"8400220","type":"CDM"},{"code":"450","type":"RC"},{"code":"27810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Trimalleolar Ankle Fract W/manip","code_information":[{"code":"8400221","type":"CDM"},{"code":"450","type":"RC"},{"code":"27818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Fract Wt Bear Artclr Prt Dst Tib","code_information":[{"code":"8400223","type":"CDM"},{"code":"450","type":"RC"},{"code":"27825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Clsd Tx Bimalleolar Ankle Fract","code_information":[{"code":"8500220","type":"CDM"},{"code":"27810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1948,"gross_charge":2435,"discounted_cash":2435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1948}]}]},{"description":"Postop Biliary Duct Calcul Rem Via Ttube","code_information":[{"code":"5000140","type":"CDM"},{"code":"329","type":"RC"},{"code":"74327","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1946,"maximum":1946,"gross_charge":2433,"discounted_cash":2433,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1946},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1946},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1946}]}]},{"description":"Arthrex 3mm Suture Anchor ..","code_information":[{"code":"2800069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1944,"maximum":1944,"gross_charge":2430,"discounted_cash":2430,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1944},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1944},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1944}]}]},{"description":"J&j 5.0ti Lckng Screw T25 Sd48 Nail","code_information":[{"code":"2802679","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1936,"maximum":1936,"gross_charge":2420,"discounted_cash":2420,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1936}]}]},{"description":"J&j 5.0ti Lckng Screw T25 Sd40 Nail","code_information":[{"code":"2802680","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1936,"maximum":1936,"gross_charge":2420,"discounted_cash":2420,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1936}]}]},{"description":"Urography Iv W/wo Kub W/wo Tomography","code_information":[{"code":"8401521","type":"CDM"},{"code":"329","type":"RC"},{"code":"74400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1935,"maximum":1935,"gross_charge":2419,"discounted_cash":2419,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1935},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1935},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1935}]}]},{"description":"Epidurography Rad Sup&int","code_information":[{"code":"5000077","type":"CDM"},{"code":"614","type":"RC"},{"code":"72275","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1928,"maximum":1928,"gross_charge":2410,"discounted_cash":2410,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1928},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1928},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1928}]}]},{"description":"Zavation 4x12mm Variable Screws","code_information":[{"code":"2800720","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1920,"maximum":1920,"gross_charge":2400,"discounted_cash":2400,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1920},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1920},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1920}]}]},{"description":"Zaviation Self Drilling Variable Screws","code_information":[{"code":"2800735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1920,"maximum":1920,"gross_charge":2400,"discounted_cash":2400,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1920},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1920},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1920}]}]},{"description":"Endoscopic Cath Pancreatic Ductal Syst","code_information":[{"code":"5000076","type":"CDM"},{"code":"329","type":"RC"},{"code":"74329","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1914,"maximum":1914,"gross_charge":2392,"discounted_cash":2392,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1914},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1914},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1914}]}]},{"description":"Mid Anesthesia 1st 30min","code_information":[{"code":"260007","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP260007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1909,"maximum":1909,"gross_charge":2386,"discounted_cash":2386,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1909}]}]},{"description":"Anesthesia 1st 30min","code_information":[{"code":"2600005","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP2600005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1909,"maximum":1909,"gross_charge":2386,"discounted_cash":2386,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1909}]}]},{"description":"Excision Of Thrombosed Hemorrhoid Ext","code_information":[{"code":"1000135","type":"CDM"},{"code":"450","type":"RC"},{"code":"46320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1909,"gross_charge":2386,"discounted_cash":2386,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1909}]}]},{"description":"Mini Quick Anchor 2.0","code_information":[{"code":"2800313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1904,"maximum":1904,"gross_charge":2380,"discounted_cash":2380,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1904}]}]},{"description":"Stryker Headless Compression Screw 7.0mm","code_information":[{"code":"2800499","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1904,"maximum":1904,"gross_charge":2380,"discounted_cash":2380,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1904}]}]},{"description":"Stryker Headless Compression Screw 7mm X","code_information":[{"code":"2800500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1904,"maximum":1904,"gross_charge":2380,"discounted_cash":2380,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1904}]}]},{"description":"Stryker Headless Compression Screw 7mm X","code_information":[{"code":"2800501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1904,"maximum":1904,"gross_charge":2380,"discounted_cash":2380,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1904}]}]},{"description":"Stryker Headless Compression Screw 7mmx4","code_information":[{"code":"2800502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1904,"maximum":1904,"gross_charge":2380,"discounted_cash":2380,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1904},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1904}]}]},{"description":"Emer Dept High Severity&threat Funcj","code_information":[{"code":"8500424","type":"CDM"},{"code":"99285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1894,"maximum":1894,"gross_charge":2367,"discounted_cash":2367,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1894},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1894},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1894}]}]},{"description":"J&j 5.0 Mm Cannulated Va Locking Screw 7","code_information":[{"code":"2800246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1892,"maximum":1892,"gross_charge":2365,"discounted_cash":2365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1892}]}]},{"description":"J&j 5.0mm Cannulated Va Locking Screw 65","code_information":[{"code":"2800249","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1892,"maximum":1892,"gross_charge":2365,"discounted_cash":2365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1892}]}]},{"description":"Synthes Jj 5.0mm Cannulated Va Locking S","code_information":[{"code":"2800636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1892,"maximum":1892,"gross_charge":2365,"discounted_cash":2365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1892}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"1000024","type":"CDM"},{"code":"450","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1891,"maximum":1891,"gross_charge":2364,"discounted_cash":2364,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1891}]}]},{"description":"Stryker Headless Compr. Scr. 4.0mm L36mm","code_information":[{"code":"2800494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1885,"maximum":1885,"gross_charge":2356,"discounted_cash":2356,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1885},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1885},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1885}]}]},{"description":"Stryker Headless Compression Screw 4.0mm","code_information":[{"code":"2800497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1885,"maximum":1885,"gross_charge":2356,"discounted_cash":2356,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1885},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1885},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1885}]}]},{"description":"Isosulfan Blue 1% 10mg/ml 5ml Vial","code_information":[{"code":"3000131","type":"CDM"},{"code":"636","type":"RC"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1872,"maximum":1872,"gross_charge":2340,"discounted_cash":2340,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1872}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dress/debrid P-thick Burn L","code_information":[{"code":"1000103","type":"CDM"},{"code":"450","type":"RC"},{"code":"16030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1870,"gross_charge":2338,"discounted_cash":2338,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1870},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1870},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1870}]}]},{"description":"Arthrex Fibertak Suture Anchor","code_information":[{"code":"2800805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1860,"maximum":1860,"gross_charge":2325,"discounted_cash":2325,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1860}]}]},{"description":"Us Aorta Dop","code_information":[{"code":"5100004","type":"CDM"},{"code":"921","type":"RC"},{"code":"93978","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1859,"gross_charge":2324,"discounted_cash":2324,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1859},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1859},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1859},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"I&d Pilonidal Cyst Simple","code_information":[{"code":"1000150","type":"CDM"},{"code":"450","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1855,"gross_charge":2319,"discounted_cash":2319,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1855},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1855},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1855}]}]},{"description":"Extr Veins Doppler Waveform Analysis","code_information":[{"code":"5100016","type":"CDM"},{"code":"921","type":"RC"},{"code":"93965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1852,"gross_charge":2315,"discounted_cash":2315,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1852},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1852},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1852},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Treat Big Toe Fracture","code_information":[{"code":"1000030","type":"CDM"},{"code":"450","type":"RC"},{"code":"28495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1843,"gross_charge":2304,"discounted_cash":2304,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1843},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1843},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1843}]}]},{"description":"Division Scalenus Antcus W/rsct Cerv Rib","code_information":[{"code":"1000093","type":"CDM"},{"code":"450","type":"RC"},{"code":"21705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":1842,"gross_charge":2302,"discounted_cash":2302,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1842},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1842},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1842}]}]},{"description":"Division Scalenus Anticus Resct Cerv Rib","code_information":[{"code":"8400159","type":"CDM"},{"code":"450","type":"RC"},{"code":"21705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1665,"maximum":1842,"gross_charge":2302,"discounted_cash":2302,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1842},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1842},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1842}]}]},{"description":"Us Ob Fetal 2-3 Trimester","code_information":[{"code":"5100053","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1840,"maximum":1840,"gross_charge":2300,"discounted_cash":2300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1840}]}]},{"description":"Us Prg Utrs Rt W/img Dc Limited","code_information":[{"code":"8401389","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1840,"maximum":1840,"gross_charge":2300,"discounted_cash":2300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1840}]}]},{"description":"Incision Thrombosed Hemorrhoid External","code_information":[{"code":"1000156","type":"CDM"},{"code":"450","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1834,"gross_charge":2293,"discounted_cash":2293,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1834}]}]},{"description":"Inj Myelography Spinal Other Than C1c3","code_information":[{"code":"2201454","type":"CDM"},{"code":"320","type":"RC"},{"code":"62284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1834,"gross_charge":2292,"discounted_cash":2292,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1834}]}]},{"description":"Wright Snap Off Screw 2.0mmx12mm","code_information":[{"code":"2800707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1830,"maximum":1830,"gross_charge":2288,"discounted_cash":2288,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1830},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1830},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1830}]}]},{"description":"Closed Tx Hip Dislocat Traumatc W/o Anes","code_information":[{"code":"1000036","type":"CDM"},{"code":"450","type":"RC"},{"code":"27250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1822,"gross_charge":2277,"discounted_cash":2277,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1822}]}]},{"description":"Application Long Leg Cast Thigh To Toes","code_information":[{"code":"1000111","type":"CDM"},{"code":"450","type":"RC"},{"code":"29345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1813,"gross_charge":2266,"discounted_cash":2266,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1813}]}]},{"description":"Arthrosurface Hemi 9.5 Taper Post","code_information":[{"code":"2800101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1812,"maximum":1812,"gross_charge":2265,"discounted_cash":2265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1812},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1812},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1812}]}]},{"description":"Removal Foreign Body From Pharynx","code_information":[{"code":"1000209","type":"CDM"},{"code":"450","type":"RC"},{"code":"42809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1811,"gross_charge":2264,"discounted_cash":2264,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1811}]}]},{"description":"Repair Complex Face 5 Cm Or Less","code_information":[{"code":"1000226","type":"CDM"},{"code":"450","type":"RC"},{"code":"13133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1806,"gross_charge":2258,"discounted_cash":2258,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1806},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1806},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1806}]}]},{"description":"Life Sciences 4.0 X14 Sd Fixed Screw","code_information":[{"code":"2800259","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1800,"maximum":1800,"gross_charge":2250,"discounted_cash":2250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1800}]}]},{"description":"Life Sciences 4.0 X14mm Sd Variable Scre","code_information":[{"code":"2800260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1800,"maximum":1800,"gross_charge":2250,"discounted_cash":2250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1800}]}]},{"description":"Nevro Patient Remote Kit","code_information":[{"code":"2800334","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1800,"maximum":1800,"gross_charge":2250,"discounted_cash":2250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1800}]}]},{"description":"Rem Foreign Bodys Esophageal W/ Balloon","code_information":[{"code":"5000150","type":"CDM"},{"code":"329","type":"RC"},{"code":"74235","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1789,"maximum":1789,"gross_charge":2236,"discounted_cash":2236,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1789},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1789},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1789}]}]},{"description":"Ti Lock Screw 2.4 X 12mm","code_information":[{"code":"2800658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1784,"maximum":1784,"gross_charge":2230,"discounted_cash":2230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1784}]}]},{"description":"Ti Lock Screw 2.4 X 14mm","code_information":[{"code":"2800659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1784,"maximum":1784,"gross_charge":2230,"discounted_cash":2230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1784}]}]},{"description":"Ti Lock Screw 2.4 X 16mm","code_information":[{"code":"2800660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1784,"maximum":1784,"gross_charge":2230,"discounted_cash":2230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1784}]}]},{"description":"Ti Lock Screw 2.4 X 18mm","code_information":[{"code":"2800661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1784,"maximum":1784,"gross_charge":2230,"discounted_cash":2230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1784}]}]},{"description":"Ti Lock Screw 2.4 X 20mm","code_information":[{"code":"2800662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1784,"maximum":1784,"gross_charge":2230,"discounted_cash":2230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1784}]}]},{"description":"Ct Limited Or Localized Followup Study","code_information":[{"code":"5200018","type":"CDM"},{"code":"352","type":"RC"},{"code":"76380","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1782,"maximum":1782,"gross_charge":2227,"discounted_cash":2227,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1782},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1782},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1782}]}]},{"description":"Arhtrex Tightrope","code_information":[{"code":"2800064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1780,"maximum":1780,"gross_charge":2225,"discounted_cash":2225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1780},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1780},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1780}]}]},{"description":"Depuy Synthes 4.5 Mm Cannulated Screw Pa","code_information":[{"code":"2800191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1780,"maximum":1780,"gross_charge":2225,"discounted_cash":2225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1780},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1780},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1780}]}]},{"description":"Insertion Of Chest Tube","code_information":[{"code":"1000283","type":"CDM"},{"code":"450","type":"RC"},{"code":"32551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1771,"gross_charge":2214,"discounted_cash":2214,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1771},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1771},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1771}]}]},{"description":"Central Motor Evoked Potential Study","code_information":[{"code":"2200458","type":"CDM"},{"code":"740","type":"RC"},{"code":"95929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1760,"maximum":2300,"gross_charge":2200,"discounted_cash":2200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1760},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1760},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1760},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Rpr F/e/e/n/l/m 7.6-12.5 Cm","code_information":[{"code":"1000256","type":"CDM"},{"code":"450","type":"RC"},{"code":"12015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1758,"gross_charge":2198,"discounted_cash":2198,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1758},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1758},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1758}]}]},{"description":"Us Venous Dop Ext Bilat Upper Or Lower","code_information":[{"code":"5100008","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1757,"gross_charge":2196,"discounted_cash":2196,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1757},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Closure Of Split Wound W/packing","code_information":[{"code":"1000282","type":"CDM"},{"code":"450","type":"RC"},{"code":"12021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1742,"gross_charge":2177,"discounted_cash":2177,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1742},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1742},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1742}]}]},{"description":"Arthrex  Suture Anchor Swivelock Tenodes","code_information":[{"code":"2800066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1740,"maximum":1740,"gross_charge":2175,"discounted_cash":2175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1740},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1740},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1740}]}]},{"description":"Cta Cor W Morph","code_information":[{"code":"5000330","type":"CDM"},{"code":"350","type":"RC"},{"code":"75574","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1731,"maximum":1731,"gross_charge":2164,"discounted_cash":2164,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1731},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1731},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1731}]}]},{"description":"Cholecystography Oral Contrast","code_information":[{"code":"5000040","type":"CDM"},{"code":"329","type":"RC"},{"code":"74290","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1729,"maximum":1729,"gross_charge":2161,"discounted_cash":2161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1729}]}]},{"description":"Duodenography Hypotonic","code_information":[{"code":"5000071","type":"CDM"},{"code":"329","type":"RC"},{"code":"74260","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1729,"maximum":1729,"gross_charge":2161,"discounted_cash":2161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1729}]}]},{"description":"Xr Xm Swlng Funcj C+","code_information":[{"code":"5000159","type":"CDM"},{"code":"329","type":"RC"},{"code":"74230","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1729,"maximum":1729,"gross_charge":2161,"discounted_cash":2161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1729}]}]},{"description":"Xr Small Bowel Series","code_information":[{"code":"5000251","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1729,"maximum":1729,"gross_charge":2161,"discounted_cash":2161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1729}]}]},{"description":"Xr Small Bowel Series","code_information":[{"code":"5000315","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1729,"maximum":1729,"gross_charge":2161,"discounted_cash":2161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1729}]}]},{"description":"Stryker Locking Screw T6 2.0mm L8mm","code_information":[{"code":"2800530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1728,"maximum":1728,"gross_charge":2160,"discounted_cash":2160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1728},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1728},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1728}]}]},{"description":"Removal Tunneled Cv Cath 1st","code_information":[{"code":"2202409","type":"CDM"},{"code":"360","type":"RC"},{"code":"36589","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1724,"gross_charge":2155,"discounted_cash":2155,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1724},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1724},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1724}]}]},{"description":"Graft, Vascular","code_information":[{"code":"28000749","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1720,"maximum":1720,"gross_charge":2150,"discounted_cash":2150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1720},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1720},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1720}]}]},{"description":"Ophth Us B & Quant A","code_information":[{"code":"5000122","type":"CDM"},{"code":"402","type":"RC"},{"code":"76510","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1714,"maximum":1714,"gross_charge":2143,"discounted_cash":2143,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1714},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1714},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1714}]}]},{"description":"Rescj/inc Subvalvular Tissue","code_information":[{"code":"8500271","type":"CDM"},{"code":"33415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1707,"maximum":1707,"gross_charge":2134,"discounted_cash":2134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1707},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1707},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1707}]}]},{"description":"Excision Of Nail Fold Toe","code_information":[{"code":"1000290","type":"CDM"},{"code":"450","type":"RC"},{"code":"11765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1706,"gross_charge":2132,"discounted_cash":2132,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1706},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1706},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1706}]}]},{"description":"Liver Function Study With Serial Images","code_information":[{"code":"5000101","type":"CDM"},{"code":"340","type":"RC"},{"code":"78220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1704,"maximum":1704,"gross_charge":2130,"discounted_cash":2130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1704},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1704},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1704}]}]},{"description":"Stryker Distal Lateral Fibula Plate 4 Ho","code_information":[{"code":"2800485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1703,"maximum":1703,"gross_charge":2129,"discounted_cash":2129,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1703},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1703},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1703}]}]},{"description":"Arthrex Nano Corkscrew Ft Ti W 3-0fw","code_information":[{"code":"2800089","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1700,"maximum":1700,"gross_charge":2125,"discounted_cash":2125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1700}]}]},{"description":"Stryker Distal Lateral Fibula Plate 3 Ho","code_information":[{"code":"2800484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1700,"maximum":1700,"gross_charge":2125,"discounted_cash":2125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1700}]}]},{"description":"Gore Seamgaurd Bioabsorbable Staple Line","code_information":[{"code":"2800224","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1698,"maximum":1698,"gross_charge":2122,"discounted_cash":2122,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1698}]}]},{"description":"Rpr S/n/a/gen/trk12.6-20.0cm","code_information":[{"code":"1000259","type":"CDM"},{"code":"450","type":"RC"},{"code":"12005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1697,"gross_charge":2121,"discounted_cash":2121,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1697},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1697},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1697}]}]},{"description":"Insert Picc Cath","code_information":[{"code":"8400277","type":"CDM"},{"code":"450","type":"RC"},{"code":"36569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":1697,"gross_charge":2121,"discounted_cash":2121,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1697},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1697},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1697},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Tetanus, Diphtheria, Pertussis Vaccine","code_information":[{"code":"3000296","type":"CDM"},{"code":"636","type":"RC"},{"code":"13533013101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1690,"maximum":1690,"gross_charge":2112,"discounted_cash":2112,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1690}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Usg Intraoperative","code_information":[{"code":"5000187","type":"CDM"},{"code":"402","type":"RC"},{"code":"76998","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1684,"maximum":1684,"gross_charge":2105,"discounted_cash":2105,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1684},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1684},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1684}]}]},{"description":"Radiation Treatment Aid(s)","code_information":[{"code":"5000177","type":"CDM"},{"code":"999","type":"RC"},{"code":"77333","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1674,"maximum":1674,"gross_charge":2093,"discounted_cash":2093,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1674}]}]},{"description":"Treatment Of Toe Fracture","code_information":[{"code":"1000034","type":"CDM"},{"code":"450","type":"RC"},{"code":"28515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1670,"gross_charge":2087,"discounted_cash":2087,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1670},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1670},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1670}]}]},{"description":"Mri Needle Placement Eg For Biopsy","code_information":[{"code":"5300058","type":"CDM"},{"code":"614","type":"RC"},{"code":"77021","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1666,"maximum":1666,"gross_charge":2082,"discounted_cash":2082,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1666}]}]},{"description":"Closed Tx Nasal Fracture W/o Stabiliz","code_information":[{"code":"8400153","type":"CDM"},{"code":"450","type":"RC"},{"code":"21315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1662,"gross_charge":2077,"discounted_cash":2077,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1662},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1662},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1662}]}]},{"description":"Treat Lower Jaw Fracture","code_information":[{"code":"8400156","type":"CDM"},{"code":"450","type":"RC"},{"code":"21451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":1662,"gross_charge":2077,"discounted_cash":2077,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1662},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1662},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1662}]}]},{"description":"Removal Foreign Body Gum","code_information":[{"code":"8400289","type":"CDM"},{"code":"450","type":"RC"},{"code":"41805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1662,"gross_charge":2077,"discounted_cash":2077,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1662},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1662},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1662}]}]},{"description":"Us Guidance For Parenchymal Tissue Ablat","code_information":[{"code":"5100030","type":"CDM"},{"code":"402","type":"RC"},{"code":"76940","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1653,"maximum":1653,"gross_charge":2066,"discounted_cash":2066,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1653},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1653},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1653}]}]},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"6100069","type":"CDM"},{"code":"521","type":"RC"},{"code":"99204","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":1649,"maximum":1649,"gross_charge":2061,"discounted_cash":2061,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1649}]}]},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"6100070","type":"CDM"},{"code":"521","type":"RC"},{"code":"99204","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":1649,"maximum":1649,"gross_charge":2061,"discounted_cash":2061,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1649}]}]},{"description":"Hospital Outpatient Clinic Visit For Ass","code_information":[{"code":"6200069","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1649,"maximum":1649,"gross_charge":2061,"discounted_cash":2061,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1649}]}]},{"description":"Spinal Puncture Lumbar Diagnostic","code_information":[{"code":"1000265","type":"CDM"},{"code":"450","type":"RC"},{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1637,"gross_charge":2046,"discounted_cash":2046,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1637},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1637},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1637}]}]},{"description":"Donnatal Elixir","code_information":[{"code":"3000080","type":"CDM"},{"code":"250","type":"RC"},{"code":"59212042204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1636,"maximum":1636,"gross_charge":2045,"discounted_cash":2045,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1636}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Us Pelvic Complete Non Ob","code_information":[{"code":"5100042","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1635,"maximum":1635,"gross_charge":2044,"discounted_cash":2044,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1635},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1635},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1635}]}]},{"description":"Application Cylinder Cast Thigh To Ankle","code_information":[{"code":"1000108","type":"CDM"},{"code":"450","type":"RC"},{"code":"29365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1635,"maximum":1635,"gross_charge":2044,"discounted_cash":2044,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1635},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1635},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1635}]}]},{"description":"Ultrasound of abdomen","code_information":[{"code":"8401377","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1623,"maximum":1623,"gross_charge":2029,"discounted_cash":2029,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1623},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1623},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1623}]}]},{"description":"Treat Toe Dislocation","code_information":[{"code":"1000049","type":"CDM"},{"code":"450","type":"RC"},{"code":"28630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1621,"gross_charge":2026,"discounted_cash":2026,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1621},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1621},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1621}]}]},{"description":"Stryker One Third Tubular Plate 6 Hole","code_information":[{"code":"2800539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1620,"maximum":1620,"gross_charge":2025,"discounted_cash":2025,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1620},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1620},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1620}]}]},{"description":"Xr Mandible Complete","code_information":[{"code":"5000238","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Bone Length Studies","code_information":[{"code":"5000033","type":"CDM"},{"code":"320","type":"RC"},{"code":"77073","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Cephalogram Orthodontic","code_information":[{"code":"5000035","type":"CDM"},{"code":"329","type":"RC"},{"code":"70350","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Dxa Bone Density Axial","code_information":[{"code":"5000070","type":"CDM"},{"code":"329","type":"RC"},{"code":"77080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Joint Survey Single View","code_information":[{"code":"5000100","type":"CDM"},{"code":"320","type":"RC"},{"code":"77077","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Pelvimetry W/wo Placental Localization","code_information":[{"code":"5000125","type":"CDM"},{"code":"329","type":"RC"},{"code":"74710","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Shuntogram For Nonvascular Shunt","code_information":[{"code":"5000152","type":"CDM"},{"code":"320","type":"RC"},{"code":"75809","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Hip Bilat Complete 3-4 Views","code_information":[{"code":"5000224","type":"CDM"},{"code":"329","type":"RC"},{"code":"73522","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Calcaneus Complete 2+ Views Rt","code_information":[{"code":"5000229","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"X-Ray of lower back","code_information":[{"code":"5000236","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr L-spine Limited 2+ Views","code_information":[{"code":"5000237","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Nasal Bone Complete","code_information":[{"code":"5000239","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Ribs Bilat 3 Views","code_information":[{"code":"5000242","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Soft Tissue Neck","code_information":[{"code":"5000252","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Thoracic Spine 4+ Views","code_information":[{"code":"5000253","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Thoracic Spine Complete","code_information":[{"code":"5000254","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Thoracic Spine Limited 2 Views","code_information":[{"code":"5000255","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Calcaneus Complete 2+ Views Lt","code_information":[{"code":"5000258","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Forearm Complete Lt","code_information":[{"code":"5000264","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Hand Complete Lt","code_information":[{"code":"5000265","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Knee 4+ Views Lt","code_information":[{"code":"5000267","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Knee Complete Lt","code_information":[{"code":"5000268","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Knee Limited 2 Views Lt","code_information":[{"code":"5000269","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Ribs Unilat W Chest 3+ Views Lt","code_information":[{"code":"5000271","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Calcaneus Complete 2+ Views","code_information":[{"code":"5000280","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Cervical Spine Comp With Flex/ext","code_information":[{"code":"5000281","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Cervical Spine Limited 2+ Views","code_information":[{"code":"5000283","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Clavicle Complete","code_information":[{"code":"5000284","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Facial Bones Complete","code_information":[{"code":"5000287","type":"CDM"},{"code":"360","type":"RC"},{"code":"70150","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Forearm Complete Rt","code_information":[{"code":"5000291","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Hand Complete Rt","code_information":[{"code":"5000292","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Knee 4+ Views Rt","code_information":[{"code":"5000294","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Knee Complete Rt","code_information":[{"code":"5000295","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"TCRT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCRT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Knee Limited 2 Views Rt","code_information":[{"code":"5000296","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"X-Ray of lower back","code_information":[{"code":"5000298","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Lumbar Spine Limited 2+ Views","code_information":[{"code":"5000299","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Mandible Complete","code_information":[{"code":"5000300","type":"CDM"},{"code":"360","type":"RC"},{"code":"70110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Nasal Bone Complete","code_information":[{"code":"5000301","type":"CDM"},{"code":"360","type":"RC"},{"code":"70160","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Ribs Bilat 3 Views","code_information":[{"code":"5000304","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Ribs Unilat W Chest 3+ Views Rt","code_information":[{"code":"5000306","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Soft Tissue Neck","code_information":[{"code":"5000316","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Thoracic Spine 4+ Views","code_information":[{"code":"5000317","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Thoracic Spine Complete","code_information":[{"code":"5000318","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Xr Thoracic Spine Limited 2 Views","code_information":[{"code":"5000319","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1615,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615}]}]},{"description":"Us Carotid Dop","code_information":[{"code":"5100006","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1615,"gross_charge":2019,"discounted_cash":2019,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Soft Tissue Ext Nonvasc","code_information":[{"code":"5100039","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1607,"maximum":1607,"gross_charge":2009,"discounted_cash":2009,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1607}]}]},{"description":"Us Extremity Nonvasc Rt W/img Doc Comp","code_information":[{"code":"8401396","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1607,"maximum":1607,"gross_charge":2009,"discounted_cash":2009,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1607}]}]},{"description":"Synthes Tubulor Plate 7 Hole","code_information":[{"code":"2800649","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1604,"maximum":1604,"gross_charge":2005,"discounted_cash":2005,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1604},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1604},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1604}]}]},{"description":"Ctl Medical 6.5x30  Polyaxial Screw","code_information":[{"code":"2800151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1600,"maximum":1600,"gross_charge":2000,"discounted_cash":2000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1600}]}]},{"description":"Genspine Pre-bent Rod 5.5 X 65","code_information":[{"code":"2800219","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1600,"maximum":1600,"gross_charge":2000,"discounted_cash":2000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1600}]}]},{"description":"Zavation Pre Bent Rod 5.5 X 40","code_information":[{"code":"2800729","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1600,"maximum":1600,"gross_charge":2000,"discounted_cash":2000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1600}]}]},{"description":"Zavation Straight Rod 5.5x80mm","code_information":[{"code":"2800730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1600,"maximum":1600,"gross_charge":2000,"discounted_cash":2000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1600}]}]},{"description":"Arthrex Canulated Screw 32mm","code_information":[{"code":"2800745","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1600,"maximum":1600,"gross_charge":2000,"discounted_cash":2000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1600}]}]},{"description":"S&n Healicoil 4.7mm","code_information":[{"code":"2800792","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1600,"maximum":1600,"gross_charge":2000,"discounted_cash":2000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1600}]}]},{"description":"Closed Treatment Of Bimalleolar Ankle Fr","code_information":[{"code":"8401527","type":"CDM"},{"code":"450","type":"RC"},{"code":"27808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1600,"gross_charge":2000,"discounted_cash":2000,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1600}]}]},{"description":"Premarin Cream 0.625mg/g","code_information":[{"code":"3000247","type":"CDM"},{"code":"636","type":"RC"},{"code":"46087","type":"CPT","modifier":"221"}],"standard_charges":[{"setting":"outpatient","modifier_code":["221"],"minimum":1589,"maximum":1589,"gross_charge":1986,"discounted_cash":1986,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1589},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1589},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1589}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Xr Hips Bilateral W/pelvis 3-4 Views","code_information":[{"code":"8401494","type":"CDM"},{"code":"329","type":"RC"},{"code":"73522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1588,"maximum":1588,"gross_charge":1985,"discounted_cash":1985,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1588}]}]},{"description":"Mri Breast","code_information":[{"code":"5300064","type":"CDM"},{"code":"614","type":"RC"},{"code":"77059","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1584,"maximum":1584,"gross_charge":1980,"discounted_cash":1980,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1584},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1584},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1584}]}]},{"description":"Arhthex Meniscal Cinch Ii","code_information":[{"code":"2800063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1580,"maximum":1580,"gross_charge":1975,"discounted_cash":1975,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1580},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1580},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1580}]}]},{"description":"Ins Non-tun Ctr Cvc Age 5 Yr/>","code_information":[{"code":"8400276","type":"CDM"},{"code":"450","type":"RC"},{"code":"36556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1578,"gross_charge":1972,"discounted_cash":1972,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1578}]}]},{"description":"Transcervical Cath Fallopian Tube Rad","code_information":[{"code":"5000175","type":"CDM"},{"code":"329","type":"RC"},{"code":"74742","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1576,"maximum":1576,"gross_charge":1970,"discounted_cash":1970,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1576},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1576},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1576}]}]},{"description":"Mammography of both breasts","code_information":[{"code":"5100074","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1571,"maximum":1571,"gross_charge":1964,"discounted_cash":1964,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1571},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1571},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1571}]}]},{"description":"Rabies Immune Globulin Rig Human For Im","code_information":[{"code":"8400349","type":"CDM"},{"code":"450","type":"RC"},{"code":"90375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1570,"maximum":1570,"gross_charge":1962,"discounted_cash":1962,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1570}]}]},{"description":"Remove Foreign Body","code_information":[{"code":"1000154","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1563,"gross_charge":1954,"discounted_cash":1954,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1563},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1563},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1563}]}]},{"description":"Injection Procedure For Antegrade Nephro","code_information":[{"code":"22100009","type":"CDM"},{"code":"360","type":"RC"},{"code":"50430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1562,"gross_charge":1953,"discounted_cash":1953,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1562},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1562},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1562}]}]},{"description":"Tube Thoracostomy Inc Conn To Drain Sys","code_information":[{"code":"8400268","type":"CDM"},{"code":"450","type":"RC"},{"code":"32551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1561,"gross_charge":1951,"discounted_cash":1951,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1561},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1561},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1561}]}]},{"description":"Echo Exam Of Fetal Heart","code_information":[{"code":"5000065","type":"CDM"},{"code":"483","type":"RC"},{"code":"76827","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":950,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Doppler Velocimetry Ftl Mid Cerebral Art","code_information":[{"code":"5000067","type":"CDM"},{"code":"402","type":"RC"},{"code":"76821","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Doppler Velocimetry Fetal Umbilical Art","code_information":[{"code":"5000068","type":"CDM"},{"code":"402","type":"RC"},{"code":"76820","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Echo Exam Of Eye","code_information":[{"code":"5100019","type":"CDM"},{"code":"402","type":"RC"},{"code":"76516","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Echo Exam Of Eye","code_information":[{"code":"5100020","type":"CDM"},{"code":"402","type":"RC"},{"code":"76519","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Us Study Followup Specify","code_information":[{"code":"5100032","type":"CDM"},{"code":"402","type":"RC"},{"code":"76970","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Us Exam Infant Hips Dynamic","code_information":[{"code":"5100040","type":"CDM"},{"code":"402","type":"RC"},{"code":"76885","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Us Exam Infant Hips Static","code_information":[{"code":"5100041","type":"CDM"},{"code":"402","type":"RC"},{"code":"76886","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Us Ob >/= 14 Wks Addl Fetus","code_information":[{"code":"5100046","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Us Unlisted Procedure","code_information":[{"code":"5100064","type":"CDM"},{"code":"402","type":"RC"},{"code":"76999","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1558,"maximum":1558,"gross_charge":1948,"discounted_cash":1948,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1558}]}]},{"description":"Wright Headed Screw 4.0mm X 30mm","code_information":[{"code":"2800701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1557,"maximum":1557,"gross_charge":1946,"discounted_cash":1946,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1557},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1557},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1557}]}]},{"description":"Us Breast Limited","code_information":[{"code":"5100027","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1553,"maximum":1553,"gross_charge":1941,"discounted_cash":1941,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1553},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1553},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1553}]}]},{"description":"Fine Needle Asp Wo Imag Guidance","code_information":[{"code":"1000138","type":"CDM"},{"code":"450","type":"RC"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1542,"gross_charge":1927,"discounted_cash":1927,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1542},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1542},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1542}]}]},{"description":"App Patellar Tendon Bearing Ptb Cast","code_information":[{"code":"1000114","type":"CDM"},{"code":"450","type":"RC"},{"code":"29435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1533,"maximum":1533,"gross_charge":1916,"discounted_cash":1916,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1533},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1533},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1533}]}]},{"description":"Exc Benign Lsn Inc Trk/arm/leg 0.6-1.0cm","code_information":[{"code":"1000130","type":"CDM"},{"code":"450","type":"RC"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1529,"gross_charge":1911,"discounted_cash":1911,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1529},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1529},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1529}]}]},{"description":"Introduction Long Gastrointestinal Tube","code_information":[{"code":"5000097","type":"CDM"},{"code":"329","type":"RC"},{"code":"74340","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1524,"maximum":1524,"gross_charge":1905,"discounted_cash":1905,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1524}]}]},{"description":"Jj 2.8 Perc Db Lcp Pla","code_information":[{"code":"28007567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1520,"maximum":1520,"gross_charge":1900,"discounted_cash":1900,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1520},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1520},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1520}]}]},{"description":"Treat Big Toe Fracture","code_information":[{"code":"1000031","type":"CDM"},{"code":"450","type":"RC"},{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1519,"gross_charge":1899,"discounted_cash":1899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1519},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1519},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1519}]}]},{"description":"Needle Electromyography Two Extremities","code_information":[{"code":"2201909","type":"CDM"},{"code":"922","type":"RC"},{"code":"95861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":1518,"gross_charge":1897,"discounted_cash":1897,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1518},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1518},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1518},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":409}]}]},{"description":"Needle Electromyography 4 Extremities","code_information":[{"code":"2202996","type":"CDM"},{"code":"922","type":"RC"},{"code":"95864","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":1518,"gross_charge":1897,"discounted_cash":1897,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1518},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1518},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1518},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":409}]}]},{"description":"Probe, Percutaneous Lumbar Discectomy","code_information":[{"code":"28000712","type":"CDM"},{"code":"279","type":"RC"},{"code":"C2614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1516,"maximum":1516,"gross_charge":1895,"discounted_cash":1895,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1516}]}]},{"description":"Xr Bone And/or Joint Imaging Whole Body","code_information":[{"code":"8401525","type":"CDM"},{"code":"340","type":"RC"},{"code":"78306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1511,"maximum":1511,"gross_charge":1889,"discounted_cash":1889,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1511},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1511},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1511}]}]},{"description":"Compatibility Test Each Unit, Electronic","code_information":[{"code":"4000397","type":"CDM"},{"code":"300","type":"RC"},{"code":"86923","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1510,"maximum":1510,"gross_charge":1887,"discounted_cash":1887,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1510}]}]},{"description":"Synthes 4.0mm Cannulated Screw 32mm","code_information":[{"code":"2800617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1508,"maximum":1508,"gross_charge":1885,"discounted_cash":1885,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1508}]}]},{"description":"Er Visit Level 3","code_information":[{"code":"1000106","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":1503,"maximum":1503,"gross_charge":1879,"discounted_cash":1879,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1503}]}]},{"description":"Evaluate Swallowing Function","code_information":[{"code":"5100014","type":"CDM"},{"code":"940","type":"RC"},{"code":"92610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":1502,"gross_charge":1878,"discounted_cash":1878,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1502},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1502},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1502},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Dress/debrid P-thick Burn M","code_information":[{"code":"1000104","type":"CDM"},{"code":"450","type":"RC"},{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1501,"gross_charge":1876,"discounted_cash":1876,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1501},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1501},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1501}]}]},{"description":"Alliance Spine Promote Osteo Pro Dbm 5cc","code_information":[{"code":"2800059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1500,"maximum":1500,"gross_charge":1875,"discounted_cash":1875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1500}]}]},{"description":"Arthrex Anchor Peek 4.75x19.1mm","code_information":[{"code":"2800075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1500,"maximum":1500,"gross_charge":1875,"discounted_cash":1875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1500}]}]},{"description":"Trilliant 3.5 X 12mm Arsenal Locking Scr","code_information":[{"code":"2800681","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1500,"maximum":1500,"gross_charge":1875,"discounted_cash":1875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1500}]}]},{"description":"Trilliant 3.5 X 14mm Arsenal Locking Scr","code_information":[{"code":"2800682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1500,"maximum":1500,"gross_charge":1875,"discounted_cash":1875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1500}]}]},{"description":"Trilliant 3.5 X 16mm Arsenal Locking Scr","code_information":[{"code":"2800683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1500,"maximum":1500,"gross_charge":1875,"discounted_cash":1875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1500}]}]},{"description":"Fluoro Physician Time More Than 1 Hour","code_information":[{"code":"5000084","type":"CDM"},{"code":"320","type":"RC"},{"code":"76001","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1500,"maximum":1500,"gross_charge":1875,"discounted_cash":1875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1500}]}]},{"description":"Intraluminal Dilation Strictures Obs","code_information":[{"code":"5000092","type":"CDM"},{"code":"329","type":"RC"},{"code":"74360","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1494,"maximum":1494,"gross_charge":1868,"discounted_cash":1868,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1494},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1494},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1494}]}]},{"description":"Wrght 3.5 X 18 Locking Screw","code_information":[{"code":"2800693","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1493,"maximum":1493,"gross_charge":1866,"discounted_cash":1866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1493},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1493},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1493}]}]},{"description":"Wright Medical 3.5 X 14mm Locking Screw","code_information":[{"code":"2800705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1493,"maximum":1493,"gross_charge":1866,"discounted_cash":1866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1493},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1493},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1493}]}]},{"description":"Wright Medical 3.5 X 16mm Locking Screw","code_information":[{"code":"2800706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1493,"maximum":1493,"gross_charge":1866,"discounted_cash":1866,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1493},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1493},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1493}]}]},{"description":"Us Breast Unilat Rt W/img Doc Inc Axilla","code_information":[{"code":"8401375","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1489,"maximum":1489,"gross_charge":1861,"discounted_cash":1861,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1489},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1489},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1489}]}]},{"description":"3d Render W/o Postprocess","code_information":[{"code":"5000001","type":"CDM"},{"code":"320","type":"RC"},{"code":"76376","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1484,"maximum":1484,"gross_charge":1855,"discounted_cash":1855,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1484}]}]},{"description":"3d Rendering W/interpret&report Ct Mri","code_information":[{"code":"8401524","type":"CDM"},{"code":"320","type":"RC"},{"code":"76376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1484,"maximum":1484,"gross_charge":1855,"discounted_cash":1855,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1484}]}]},{"description":"Arthrex Tightrope Rt","code_information":[{"code":"2800098","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1480,"maximum":1480,"gross_charge":1850,"discounted_cash":1850,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1480}]}]},{"description":"Stryker 2.5 X 10mm Force Fiber Anchor Ki","code_information":[{"code":"2800430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1480,"maximum":1480,"gross_charge":1850,"discounted_cash":1850,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1480}]}]},{"description":"Medtronic Hyphon Xpede Bone Cement And K","code_information":[{"code":"2800291","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1476,"maximum":1476,"gross_charge":1845,"discounted_cash":1845,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1476}]}]},{"description":"Xr Gi Trc Up Air Cont W/spec High Dens B","code_information":[{"code":"8401520","type":"CDM"},{"code":"329","type":"RC"},{"code":"74247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1471,"maximum":1471,"gross_charge":1839,"discounted_cash":1839,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1471},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1471},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1471}]}]},{"description":"Clsd Tx Distal Radioulnar Disloc W/manip","code_information":[{"code":"8400187","type":"CDM"},{"code":"450","type":"RC"},{"code":"25675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1470,"gross_charge":1837,"discounted_cash":1837,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1470}]}]},{"description":"Treat Elbow Dislocation","code_information":[{"code":"1000062","type":"CDM"},{"code":"450","type":"RC"},{"code":"24640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1466,"maximum":1466,"gross_charge":1833,"discounted_cash":1833,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1466},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1466},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1466}]}]},{"description":"Clsd Tx Supra/transcondylar Humeral Frct","code_information":[{"code":"8400169","type":"CDM"},{"code":"450","type":"RC"},{"code":"24530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1460,"gross_charge":1825,"discounted_cash":1825,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1460},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1460},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1460}]}]},{"description":"Emergency Depart Visit For The Eval","code_information":[{"code":"1000127","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1440,"maximum":1440,"gross_charge":1800,"discounted_cash":1800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1440}]}]},{"description":"Fluoro Guide Per Vertebral Body","code_information":[{"code":"5000149","type":"CDM"},{"code":"614","type":"RC"},{"code":"72291","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1440,"maximum":1440,"gross_charge":1800,"discounted_cash":1800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1440}]}]},{"description":"Drainage Finger Abscess Simple","code_information":[{"code":"8400188","type":"CDM"},{"code":"450","type":"RC"},{"code":"26010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1439,"maximum":1439,"gross_charge":1799,"discounted_cash":1799,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1439},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1439},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1439}]}]},{"description":"Application Of Long Leg Cast","code_information":[{"code":"1000112","type":"CDM"},{"code":"450","type":"RC"},{"code":"29355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1438,"maximum":1438,"gross_charge":1798,"discounted_cash":1798,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1438},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1438}]}]},{"description":"Clsd Tx Knee Dislocation Wo Anes","code_information":[{"code":"8400212","type":"CDM"},{"code":"450","type":"RC"},{"code":"27550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1434,"gross_charge":1792,"discounted_cash":1792,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1434},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1434},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1434}]}]},{"description":"Arthrex Wedged Profile Plate","code_information":[{"code":"2800099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1432,"maximum":1432,"gross_charge":1790,"discounted_cash":1790,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1432}]}]},{"description":"Catheter, Transluminal Angioplasty, Non-","code_information":[{"code":"22100133","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1429,"maximum":1429,"gross_charge":1786,"discounted_cash":1786,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1429},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1429},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1429}]}]},{"description":"Oph Us Dx Ant Sgm Us Uni/bi","code_information":[{"code":"5100021","type":"CDM"},{"code":"402","type":"RC"},{"code":"76513","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1419,"maximum":1419,"gross_charge":1774,"discounted_cash":1774,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1419}]}]},{"description":"Floseal 10ml","code_information":[{"code":"3000098","type":"CDM"},{"code":"636","type":"RC"},{"code":"56109770000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1418,"maximum":1418,"gross_charge":1772,"discounted_cash":1772,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1418}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Rpr Lip Full Thkns Vermilion Only","code_information":[{"code":"8400282","type":"CDM"},{"code":"450","type":"RC"},{"code":"40650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1416,"gross_charge":1770,"discounted_cash":1770,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1416},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1416},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1416}]}]},{"description":"Fine Needle Asp W Imag Guidance","code_information":[{"code":"1000137","type":"CDM"},{"code":"450","type":"RC"},{"code":"10022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1414,"maximum":1414,"gross_charge":1768,"discounted_cash":1768,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1414},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1414},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1414}]}]},{"description":"Vancomycin","code_information":[{"code":"4000389","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1412,"maximum":1412,"gross_charge":1765,"discounted_cash":1765,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1412}]}]},{"description":"Vancomycin Peak","code_information":[{"code":"4099991","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1412,"maximum":1412,"gross_charge":1765,"discounted_cash":1765,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1412}]}]},{"description":"Usg For Endomyocardial Bx Imaging","code_information":[{"code":"5000182","type":"CDM"},{"code":"402","type":"RC"},{"code":"76932","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1412,"maximum":1412,"gross_charge":1765,"discounted_cash":1765,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1412}]}]},{"description":"Pt Eval Low Complex 20 Min","code_information":[{"code":"6100015","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":1408,"gross_charge":1760,"discounted_cash":1760,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Eval Low Complex 20 Min","code_information":[{"code":"6100025","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":1408,"gross_charge":1760,"discounted_cash":1760,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Eval Low Complex 20 Min","code_information":[{"code":"6100026","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":1408,"gross_charge":1760,"discounted_cash":1760,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"I&d Ischiorct&/prirct Absc Spx","code_information":[{"code":"8400296","type":"CDM"},{"code":"360","type":"RC"},{"code":"46040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Encl/exc Xtrnl Thrombotic Hemorrhoid","code_information":[{"code":"8400299","type":"CDM"},{"code":"450","type":"RC"},{"code":"46320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"J&j 5.0 Va Locking Screw Slf Tpng Sd 36","code_information":[{"code":"2800248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Synthes Jj 5.0 Va Locking Scre 34","code_information":[{"code":"2800630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Synthes Jj 5.0 Va Locking Scre 70","code_information":[{"code":"2800631","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Synthes Jj 5.0 Va Locking Scre Self Tapp","code_information":[{"code":"2800632","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Synthes Jj 5.0 Va Locking Screw 40","code_information":[{"code":"2800633","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Synthes Jj 5.0 Va Locking Screw Self Tap","code_information":[{"code":"2800634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Synthes Jj 5.0 Va Locking Screws 65","code_information":[{"code":"2800635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Us Retroperitoneal Limited","code_information":[{"code":"5100056","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1404,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"Catheter, Hemodialysis/peritoneal, Short","code_information":[{"code":"81000760","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1402,"maximum":1402,"gross_charge":1753,"discounted_cash":1753,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1402}]}]},{"description":"Inj Anes Agent Pudendal Nerve","code_information":[{"code":"1000163","type":"CDM"},{"code":"450","type":"RC"},{"code":"64430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1401,"gross_charge":1751,"discounted_cash":1751,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1401}]}]},{"description":"Inf Agent Det Dna/rna Gardnere Vaginalis","code_information":[{"code":"4000227","type":"CDM"},{"code":"300","type":"RC"},{"code":"87510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1401,"maximum":1401,"gross_charge":1751,"discounted_cash":1751,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1401}]}]},{"description":"Inovasis Prebent Rod 5.5x115cm","code_information":[{"code":"2800233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1400,"maximum":1400,"gross_charge":1750,"discounted_cash":1750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"Life Spine Rod 5.5x90mm","code_information":[{"code":"2800273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1400,"maximum":1400,"gross_charge":1750,"discounted_cash":1750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"Closed Tx Nose Fx W/o Manj","code_information":[{"code":"1000050","type":"CDM"},{"code":"450","type":"RC"},{"code":"21310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1397,"maximum":1397,"gross_charge":1746,"discounted_cash":1746,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1397},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1397},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1397}]}]},{"description":"Atrium Mesh C-cur Fx","code_information":[{"code":"2800112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1392,"maximum":1392,"gross_charge":1740,"discounted_cash":1740,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1392},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1392},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1392}]}]},{"description":"Us Retroperitoneal Rt W/img Doc Complete","code_information":[{"code":"8401379","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1390,"maximum":1390,"gross_charge":1737,"discounted_cash":1737,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1390},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1390},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1390}]}]},{"description":"Usg For Intrauterine Fetal Transfus","code_information":[{"code":"5000184","type":"CDM"},{"code":"402","type":"RC"},{"code":"76941","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1374,"maximum":1374,"gross_charge":1718,"discounted_cash":1718,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1374},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1374},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1374}]}]},{"description":"Cmplx Rpr S/a/l 1.1-2.5 Cm","code_information":[{"code":"1000229","type":"CDM"},{"code":"450","type":"RC"},{"code":"13122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1363,"gross_charge":1704,"discounted_cash":1704,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1363},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1363},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1363}]}]},{"description":"Vaginal Delivery Only","code_information":[{"code":"8500316","type":"CDM"},{"code":"59409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1363,"gross_charge":1704,"discounted_cash":1704,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1363},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1363},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1363}]}]},{"description":"Stryker 2.5mm Headless Screw 18mm Length","code_information":[{"code":"2800432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1362,"maximum":1362,"gross_charge":1702,"discounted_cash":1702,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1362},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1362},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1362}]}]},{"description":"Ortho Blas Ii Putty 5cc","code_information":[{"code":"2800338","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1360,"maximum":1360,"gross_charge":1700,"discounted_cash":1700,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1360}]}]},{"description":"Osteoselect Bone Putty 2.5cc","code_information":[{"code":"2800343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1360,"maximum":1360,"gross_charge":1700,"discounted_cash":1700,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1360}]}]},{"description":"Xr Exam Hip Uni 4/> Views","code_information":[{"code":"5000212","type":"CDM"},{"code":"329","type":"RC"},{"code":"73503","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":1353,"maximum":1353,"gross_charge":1691,"discounted_cash":1691,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1353},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1353},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1353}]}]},{"description":"Xr Hips Unilateral W/pelvis Min 4 Vw","code_information":[{"code":"8401491","type":"CDM"},{"code":"329","type":"RC"},{"code":"73503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1353,"maximum":1353,"gross_charge":1691,"discounted_cash":1691,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1353},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1353},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1353}]}]},{"description":"B.s. Click X Anchor","code_information":[{"code":"2800120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1350,"maximum":1350,"gross_charge":1688,"discounted_cash":1688,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1350}]}]},{"description":"Arthrex Biocomposite Inter-ference Scrw2","code_information":[{"code":"2800079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1344,"maximum":1344,"gross_charge":1680,"discounted_cash":1680,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1344}]}]},{"description":"Xr Exam Entire Spi 2/3 Vw","code_information":[{"code":"5000214","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1342,"maximum":1342,"gross_charge":1677,"discounted_cash":1677,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1342},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1342},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1342}]}]},{"description":"Synthes 1/3 Tubular 6 Hole Plate","code_information":[{"code":"2800569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1336,"maximum":1336,"gross_charge":1670,"discounted_cash":1670,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1336}]}]},{"description":"Synthes One Third Tubular Lcp Plates Wit","code_information":[{"code":"2800641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1336,"maximum":1336,"gross_charge":1670,"discounted_cash":1670,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1336}]}]},{"description":"Intravascular Us Noncoronary Vessel","code_information":[{"code":"5000094","type":"CDM"},{"code":"402","type":"RC"},{"code":"75946","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1334,"maximum":1334,"gross_charge":1668,"discounted_cash":1668,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1334},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1334},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1334}]}]},{"description":"Puncture Aspiration Of Hematoma/cyst","code_information":[{"code":"1000194","type":"CDM"},{"code":"450","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1332,"gross_charge":1665,"discounted_cash":1665,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1332},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1332},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1332}]}]},{"description":"Ultrasound, Elastography; Parenchyma (E","code_information":[{"code":"5100071","type":"CDM"},{"code":"761","type":"RC"},{"code":"76981","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1326,"maximum":1326,"gross_charge":1657,"discounted_cash":1657,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1326}]}]},{"description":"Xr Wrist Arthrography Rad Sup&int","code_information":[{"code":"8401485","type":"CDM"},{"code":"359","type":"RC"},{"code":"73115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1314,"maximum":1314,"gross_charge":1643,"discounted_cash":1643,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1314}]}]},{"description":"Medtronic Screws 4.0 X 13","code_information":[{"code":"2800302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1314,"maximum":1314,"gross_charge":1643,"discounted_cash":1643,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1314}]}]},{"description":"Xr Finger 2 Views Rt","code_information":[{"code":"5000233","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1314,"maximum":1314,"gross_charge":1642,"discounted_cash":1642,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1314}]}]},{"description":"Xr Finger 2 Views Lt","code_information":[{"code":"5000261","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1314,"maximum":1314,"gross_charge":1642,"discounted_cash":1642,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1314}]}]},{"description":"Xr Hand Limited 2 Views Lt","code_information":[{"code":"5000266","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1314,"maximum":1314,"gross_charge":1642,"discounted_cash":1642,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1314}]}]},{"description":"Xr Finger 2 Views","code_information":[{"code":"5000288","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1314,"maximum":1314,"gross_charge":1642,"discounted_cash":1642,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1314}]}]},{"description":"Xr Hand Limited 2 Views Rt","code_information":[{"code":"5000293","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1314,"maximum":1314,"gross_charge":1642,"discounted_cash":1642,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1314}]}]},{"description":"Rpr S/n/ax/gen/trk7.6-12.5cm","code_information":[{"code":"1000262","type":"CDM"},{"code":"450","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1313,"gross_charge":1641,"discounted_cash":1641,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1313},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1313},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1313}]}]},{"description":"Us Dup-scn Xtr Veins Compl Bi Std","code_information":[{"code":"8401407","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1311,"gross_charge":1639,"discounted_cash":1639,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1311},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1311},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Tobramycin","code_information":[{"code":"4000366","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1309,"maximum":1309,"gross_charge":1636,"discounted_cash":1636,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1309},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1309},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1309}]}]},{"description":"Depuy 1.8mm Quick Coupling 110mm","code_information":[{"code":"2800161","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1304,"maximum":1304,"gross_charge":1630,"discounted_cash":1630,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1304},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1304},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1304}]}]},{"description":"Metro 2.5 Countersink","code_information":[{"code":"2800764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1299,"maximum":1299,"gross_charge":1624,"discounted_cash":1624,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1299}]}]},{"description":"Us Prg Utrs Rt W/img Dc Ftl&mtrl Evl Fir","code_information":[{"code":"8401382","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1299,"maximum":1299,"gross_charge":1624,"discounted_cash":1624,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1299}]}]},{"description":"Radiation Treatment Aid(s)","code_information":[{"code":"5000178","type":"CDM"},{"code":"999","type":"RC"},{"code":"77332","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1298,"maximum":1298,"gross_charge":1623,"discounted_cash":1623,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1298}]}]},{"description":"Clear Outer Ear Canal","code_information":[{"code":"1000195","type":"CDM"},{"code":"450","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1298,"maximum":1298,"gross_charge":1623,"discounted_cash":1623,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1298}]}]},{"description":"Smartset Ghv Centamicin One Cement 40g","code_information":[{"code":"2800367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1298,"maximum":1298,"gross_charge":1622,"discounted_cash":1622,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1298}]}]},{"description":"Xr Rib Bil Inc Posteroant Chest M 4 V","code_information":[{"code":"8401452","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1295,"maximum":1295,"gross_charge":1619,"discounted_cash":1619,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1295}]}]},{"description":"Insert Bladder Cath Complex","code_information":[{"code":"1000178","type":"CDM"},{"code":"450","type":"RC"},{"code":"51703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1295,"gross_charge":1619,"discounted_cash":1619,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1295}]}]},{"description":"Change Cath Into Renal Pelvis For Dranag","code_information":[{"code":"5000036","type":"CDM"},{"code":"320","type":"RC"},{"code":"75984","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1293,"maximum":1293,"gross_charge":1616,"discounted_cash":1616,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1293},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1293}]}]},{"description":"Emer Dept Moderate Severity","code_information":[{"code":"8400422","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1284,"maximum":1284,"gross_charge":1605,"discounted_cash":1605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1284},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1284},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1284}]}]},{"description":"Stryker Cannulated Countersink 4.0mm","code_information":[{"code":"2800480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1283,"maximum":1283,"gross_charge":1604,"discounted_cash":1604,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1283}]}]},{"description":"Destruct B9 Lesion 1-16","code_information":[{"code":"1000090","type":"CDM"},{"code":"450","type":"RC"},{"code":"64640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1281,"gross_charge":1601,"discounted_cash":1601,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1281},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1281},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1281}]}]},{"description":"Dstrj Nulyt Oth Prph Nrv/branch","code_information":[{"code":"8400333","type":"CDM"},{"code":"450","type":"RC"},{"code":"64640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1281,"gross_charge":1601,"discounted_cash":1601,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1281},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1281},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1281}]}]},{"description":"Genspine Screw St Spine Zavation Ns","code_information":[{"code":"2800220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1280,"maximum":1280,"gross_charge":1600,"discounted_cash":1600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1280}]}]},{"description":"Removal Of Toe","code_information":[{"code":"1000035","type":"CDM"},{"code":"450","type":"RC"},{"code":"28150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1278,"gross_charge":1597,"discounted_cash":1597,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1278}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"5100069","type":"CDM"},{"code":"401","type":"RC"},{"code":"77067","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1277,"maximum":1277,"gross_charge":1596,"discounted_cash":1596,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1277},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1277},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1277}]}]},{"description":"Us Abdomen Limited","code_information":[{"code":"5100035","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1275,"maximum":1275,"gross_charge":1594,"discounted_cash":1594,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1275}]}]},{"description":"Us Abdominal Rt W/img Doc Limited","code_information":[{"code":"8401378","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1275,"maximum":1275,"gross_charge":1594,"discounted_cash":1594,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1275}]}]},{"description":"Us Scrotum","code_information":[{"code":"5100057","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1272,"maximum":1272,"gross_charge":1590,"discounted_cash":1590,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1272},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1272},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1272}]}]},{"description":"Xr Ankle Arthrography Rad Sup&int","code_information":[{"code":"8401507","type":"CDM"},{"code":"359","type":"RC"},{"code":"73615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1271,"maximum":1271,"gross_charge":1589,"discounted_cash":1589,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1271},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1271},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1271}]}]},{"description":"Echo Exam Of Fetal Heart","code_information":[{"code":"5000066","type":"CDM"},{"code":"483","type":"RC"},{"code":"76828","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":950,"maximum":1271,"gross_charge":1589,"discounted_cash":1589,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1271},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1271},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1271},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":950}]}]},{"description":"Emer Dept Hi Severity&urgent Eval","code_information":[{"code":"8500423","type":"CDM"},{"code":"99284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1270,"maximum":1270,"gross_charge":1588,"discounted_cash":1588,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1270}]}]},{"description":"Clsd Tx Femoral Shaft Fract W/manip","code_information":[{"code":"8500210","type":"CDM"},{"code":"27502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1265,"gross_charge":1581,"discounted_cash":1581,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1265},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1265},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1265}]}]},{"description":"Clsd Tx Patellar Fract Wo Manip","code_information":[{"code":"8400211","type":"CDM"},{"code":"450","type":"RC"},{"code":"27520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1264,"gross_charge":1580,"discounted_cash":1580,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1264}]}]},{"description":"Inj Anes Agent Trigeminal Nrv","code_information":[{"code":"1000166","type":"CDM"},{"code":"450","type":"RC"},{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1262,"gross_charge":1578,"discounted_cash":1578,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1262}]}]},{"description":"Introducer/sheath, Other Than Guiding","code_information":[{"code":"22100132","type":"CDM"},{"code":"270","type":"RC"},{"code":"C2629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1260,"maximum":1260,"gross_charge":1575,"discounted_cash":1575,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1260}]}]},{"description":"Established Pt Hi Severity&urgent Eval","code_information":[{"code":"6100077","type":"CDM"},{"code":"450","type":"RC"},{"code":"99214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1258,"maximum":1258,"gross_charge":1572,"discounted_cash":1572,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1258}]}]},{"description":"Established Pt Hi Severity&urgent Eval","code_information":[{"code":"6100078","type":"CDM"},{"code":"450","type":"RC"},{"code":"99214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1258,"maximum":1258,"gross_charge":1572,"discounted_cash":1572,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1258}]}]},{"description":"Rabies Vaccine For Im Use","code_information":[{"code":"8400826","type":"CDM"},{"code":"250","type":"RC"},{"code":"90675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1258,"maximum":1258,"gross_charge":1572,"discounted_cash":1572,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1258}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Set Radiation Therapy Field","code_information":[{"code":"5000168","type":"CDM"},{"code":"329","type":"RC"},{"code":"77280","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1254,"maximum":1254,"gross_charge":1567,"discounted_cash":1567,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1254},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1254},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1254}]}]},{"description":"Drainage Of Gland Abscess","code_information":[{"code":"1000145","type":"CDM"},{"code":"450","type":"RC"},{"code":"56420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1251,"gross_charge":1564,"discounted_cash":1564,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1251},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1251},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1251}]}]},{"description":"Usg Pericardiocentesis","code_information":[{"code":"5000186","type":"CDM"},{"code":"402","type":"RC"},{"code":"76930","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1251,"maximum":1251,"gross_charge":1564,"discounted_cash":1564,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1251},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1251},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1251}]}]},{"description":"Set Radiation Therapy Field","code_information":[{"code":"5000170","type":"CDM"},{"code":"329","type":"RC"},{"code":"77262","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1250,"maximum":1250,"gross_charge":1563,"discounted_cash":1563,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1250}]}]},{"description":"Injection Anes Agent Facial Nerve","code_information":[{"code":"1000160","type":"CDM"},{"code":"450","type":"RC"},{"code":"64402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1250,"maximum":1250,"gross_charge":1562,"discounted_cash":1562,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1250}]}]},{"description":"Mammography of one breast","code_information":[{"code":"5100072","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1247,"maximum":1247,"gross_charge":1559,"discounted_cash":1559,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1247},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1247},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1247}]}]},{"description":"Cmplx Rpr Trunk Ea Add Cm/<","code_information":[{"code":"1000232","type":"CDM"},{"code":"450","type":"RC"},{"code":"13102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1245,"gross_charge":1556,"discounted_cash":1556,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1245},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1245},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1245}]}]},{"description":"J&j L Screw 12","code_information":[{"code":"2800769","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1240,"maximum":1240,"gross_charge":1550,"discounted_cash":1550,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1240}]}]},{"description":"J&j L Screw 14","code_information":[{"code":"2800770","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1240,"maximum":1240,"gross_charge":1550,"discounted_cash":1550,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1240}]}]},{"description":"J&j L Screw 16","code_information":[{"code":"2800771","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1240,"maximum":1240,"gross_charge":1550,"discounted_cash":1550,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1240}]}]},{"description":"J&j Va L Screw 10","code_information":[{"code":"2800773","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1240,"maximum":1240,"gross_charge":1550,"discounted_cash":1550,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1240}]}]},{"description":"Curette/treat Cornea","code_information":[{"code":"1000198","type":"CDM"},{"code":"450","type":"RC"},{"code":"65435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1239,"gross_charge":1549,"discounted_cash":1549,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1239}]}]},{"description":"Rem Corneal Epithelium W/wo Chemocauteri","code_information":[{"code":"8400339","type":"CDM"},{"code":"450","type":"RC"},{"code":"65435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1239,"gross_charge":1549,"discounted_cash":1549,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1239}]}]},{"description":"Iv/subq Inj Casirivimab&imdevimab","code_information":[{"code":"8400434","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1238,"maximum":1238,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}]},{"description":"Bamlanivimab Eli Lilly Infusion","code_information":[{"code":"8401097","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1238,"maximum":1238,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}]},{"description":"Bamlanivimab&etesevimab Eli Lillyiv Inf","code_information":[{"code":"8401098","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1238,"maximum":1238,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}]},{"description":"Rpr F/e/e/n/l/m 2.6-5.0 Cm","code_information":[{"code":"1000255","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1235,"maximum":1235,"gross_charge":1544,"discounted_cash":1544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1235}]}]},{"description":"Rpr F/e/e/n/l/m 5.1-7.5 Cm","code_information":[{"code":"1000258","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1235,"gross_charge":1544,"discounted_cash":1544,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1235}]}]},{"description":"Clsd Tx Radial/ulnar Shaft Fract Wo/man","code_information":[{"code":"8400179","type":"CDM"},{"code":"450","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1232,"gross_charge":1540,"discounted_cash":1540,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1232}]}]},{"description":"Stryker Compression Screw 4x40mm","code_information":[{"code":"2800482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1232,"gross_charge":1540,"discounted_cash":1540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1232}]}]},{"description":"Stryker Headless Compres Screw 4x34mm","code_information":[{"code":"2800495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1232,"gross_charge":1540,"discounted_cash":1540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1232}]}]},{"description":"Stryker Headless Compression Screw 4mm /","code_information":[{"code":"2800498","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1232,"maximum":1232,"gross_charge":1540,"discounted_cash":1540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1232}]}]},{"description":"Abdomial ultrasound of pregnant uterus","code_information":[{"code":"8401384","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1230,"maximum":1230,"gross_charge":1537,"discounted_cash":1537,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1230}]}]},{"description":"Anchor Surtak Small Joint 14.5*3","code_information":[{"code":"2811524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1224,"maximum":1224,"gross_charge":1530,"discounted_cash":1530,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1224}]}]},{"description":"Depuy Variable Andle Locking Screw 36mm","code_information":[{"code":"2800197","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1220,"maximum":1220,"gross_charge":1525,"discounted_cash":1525,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1220}]}]},{"description":"Stryker Locking Screw","code_information":[{"code":"2800510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1220,"maximum":1220,"gross_charge":1525,"discounted_cash":1525,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1220}]}]},{"description":"Stryker Locking Screw T8 3.5 X 18mm","code_information":[{"code":"2800531","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1220,"maximum":1220,"gross_charge":1525,"discounted_cash":1525,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1220}]}]},{"description":"Open Treatment Of Rib Fracture W/int Fix","code_information":[{"code":"8500160","type":"CDM"},{"code":"21812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1220,"maximum":1232,"gross_charge":1525,"discounted_cash":1525,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1220}]}]},{"description":"Thrombolytic Therapy Stroke","code_information":[{"code":"1000277","type":"CDM"},{"code":"450","type":"RC"},{"code":"37195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1218,"maximum":1218,"gross_charge":1523,"discounted_cash":1523,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1218},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1218},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1218}]}]},{"description":"Us Limited Anatomic Specific","code_information":[{"code":"5100028","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1217,"maximum":1217,"gross_charge":1521,"discounted_cash":1521,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1217},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1217},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1217}]}]},{"description":"3.5mm Variable Angle Locking Screw 75mm","code_information":[{"code":"2800015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1216,"maximum":1216,"gross_charge":1520,"discounted_cash":1520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1216}]}]},{"description":"Depuy 3.5mm Variable Andle Locking Screw","code_information":[{"code":"2800163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1216,"maximum":1216,"gross_charge":1520,"discounted_cash":1520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1216}]}]},{"description":"Depuy Synthes 3.5mm Variable Angle Lckng","code_information":[{"code":"2800190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1216,"maximum":1216,"gross_charge":1520,"discounted_cash":1520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1216}]}]},{"description":"Synthes Va Locking Screw 60mm","code_information":[{"code":"2800652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1216,"maximum":1216,"gross_charge":1520,"discounted_cash":1520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1216}]}]},{"description":"Synthes Va Locking Screw 65mm","code_information":[{"code":"2800653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1216,"maximum":1216,"gross_charge":1520,"discounted_cash":1520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1216}]}]},{"description":"Us Pelvic (Nonob) Rt W/img Doc Complete","code_information":[{"code":"8401393","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1212,"maximum":1212,"gross_charge":1515,"discounted_cash":1515,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1212}]}]},{"description":"Clsd Tx Medial Malleolus Fract Wo Manip","code_information":[{"code":"8400216","type":"CDM"},{"code":"450","type":"RC"},{"code":"27760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1209,"gross_charge":1511,"discounted_cash":1511,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1209},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1209},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1209}]}]},{"description":"3,5mm Conical Screw 70mm","code_information":[{"code":"2800007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1208,"maximum":1208,"gross_charge":1510,"discounted_cash":1510,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"J&j Va-lckng Screw Slf-tpng T4 Sd Rec 9","code_information":[{"code":"2800808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1208,"maximum":1208,"gross_charge":1510,"discounted_cash":1510,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Closed Tx Ipj Dislocation W/o Anesthesia","code_information":[{"code":"1000038","type":"CDM"},{"code":"450","type":"RC"},{"code":"28660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1205,"gross_charge":1506,"discounted_cash":1506,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1205},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1205},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1205}]}]},{"description":"Debrd Subq Tissue Incl Epiderm/dermis","code_information":[{"code":"1000088","type":"CDM"},{"code":"450","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1202,"gross_charge":1503,"discounted_cash":1503,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1202}]}]},{"description":"Cont Intraop Neuromonitoring Outside Or","code_information":[{"code":"2200588","type":"CDM"},{"code":"740","type":"RC"},{"code":"95941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":2300,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Evolution 14mm Sdf Screws","code_information":[{"code":"2800203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Evolution 14mm Spv Screws","code_information":[{"code":"2800204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Genspine 4.0 16mm Self Drilling Variable","code_information":[{"code":"2800216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Spinal Element 70mm Rod","code_information":[{"code":"2800369","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Spinal Elements 40mmrod","code_information":[{"code":"2800383","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Spinal Elements 50mm Rod","code_information":[{"code":"2800385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Spinal Elements 60mm Rods","code_information":[{"code":"2800395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Spinal Elements 65mm Rod","code_information":[{"code":"2800396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Trilliant 4.0 X 26mm Tiger Screw","code_information":[{"code":"2800685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1200,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Transcatheter Placement Of Intravascular","code_information":[{"code":"22000087","type":"CDM"},{"code":"360","type":"RC"},{"code":"36908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1200,"gross_charge":1500,"discounted_cash":1500,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1200}]}]},{"description":"Us Retroperitoneal Rt W/img Doc Limited","code_information":[{"code":"8401380","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1195,"maximum":1195,"gross_charge":1494,"discounted_cash":1494,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1195},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1195},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1195}]}]},{"description":"Jj 3.5 Locking Screw Slftpng","code_information":[{"code":"28007568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1188,"maximum":1188,"gross_charge":1485,"discounted_cash":1485,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1188},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1188},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1188}]}]},{"description":"Jj 3.5 Locking Screw Slftpng Recess","code_information":[{"code":"28007569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1188,"maximum":1188,"gross_charge":1485,"discounted_cash":1485,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1188},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1188},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1188}]}]},{"description":"Drainage Of Skin Abscess","code_information":[{"code":"1000143","type":"CDM"},{"code":"450","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1182,"gross_charge":1478,"discounted_cash":1478,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1182}]}]},{"description":"Drainage Of Skin Abscess 1st","code_information":[{"code":"1000144","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1182,"gross_charge":1478,"discounted_cash":1478,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1182}]}]},{"description":"Arthrex 10x30mm Bc If Screw Vented","code_information":[{"code":"2800067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1180,"maximum":1180,"gross_charge":1475,"discounted_cash":1475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1180}]}]},{"description":"Arthrex 8x20mm Bc If Screw, Vneted","code_information":[{"code":"2800072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1180,"maximum":1180,"gross_charge":1475,"discounted_cash":1475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1180}]}]},{"description":"Arthrex 9x20mm Screw Vented","code_information":[{"code":"2800073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1180,"maximum":1180,"gross_charge":1475,"discounted_cash":1475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1180}]}]},{"description":"Synthes 2.4mm Variable Angle Locking Scr","code_information":[{"code":"2800578","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1176,"maximum":1176,"gross_charge":1470,"discounted_cash":1470,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1176}]}]},{"description":"Synthes 2.4x12mm Locking Screw","code_information":[{"code":"2800579","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1176,"maximum":1176,"gross_charge":1470,"discounted_cash":1470,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1176}]}]},{"description":"Synthes Va Locking Screw 16mmc","code_information":[{"code":"2800650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1176,"maximum":1176,"gross_charge":1470,"discounted_cash":1470,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1176}]}]},{"description":"Synthes Va Locking Screw 18,mm","code_information":[{"code":"2800651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1176,"maximum":1176,"gross_charge":1470,"discounted_cash":1470,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1176}]}]},{"description":"Needle Electromyography Cranial Nerve","code_information":[{"code":"2201908","type":"CDM"},{"code":"740","type":"RC"},{"code":"95868","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1176,"maximum":2300,"gross_charge":1470,"discounted_cash":1470,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Us Venous Dop Ext Unilat Upper Or Lower","code_information":[{"code":"5100009","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1060,"maximum":1173,"gross_charge":1466,"discounted_cash":1466,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1173},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1173},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Ethicon Mesh 12x12","code_information":[{"code":"2800200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1171,"maximum":1171,"gross_charge":1464,"discounted_cash":1464,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1171}]}]},{"description":"Infectious Agent Det Hiv1 Quantification","code_information":[{"code":"4000235","type":"CDM"},{"code":"300","type":"RC"},{"code":"87536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1170,"maximum":1170,"gross_charge":1463,"discounted_cash":1463,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1170}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"8500338","type":"CDM"},{"code":"65235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1169,"gross_charge":1461,"discounted_cash":1461,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1169}]}]},{"description":"Reposition Gastrostomy Tube","code_information":[{"code":"1000251","type":"CDM"},{"code":"450","type":"RC"},{"code":"43761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1168,"gross_charge":1460,"discounted_cash":1460,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1168}]}]},{"description":"Appl Long Arm Splint Shoulder-hand","code_information":[{"code":"1000110","type":"CDM"},{"code":"450","type":"RC"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1164,"maximum":1164,"gross_charge":1455,"discounted_cash":1455,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1164},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1164},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1164}]}]},{"description":"X Ray Pelvis 1 Or 2 Views","code_information":[{"code":"8401466","type":"CDM"},{"code":"359","type":"RC"},{"code":"72170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1162,"maximum":1162,"gross_charge":1453,"discounted_cash":1453,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1162}]}]},{"description":"Cardinal Plug Perfix Med 1.3x1.55in Hern","code_information":[{"code":"2800135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1162,"maximum":1162,"gross_charge":1452,"discounted_cash":1452,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1162}]}]},{"description":"Laryngoscopy Flexible W/emoval Of Fb","code_information":[{"code":"8400265","type":"CDM"},{"code":"450","type":"RC"},{"code":"31577","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1158,"gross_charge":1448,"discounted_cash":1448,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1158}]}]},{"description":"J&j 1.5va Lkng Screw Slftpng T4 Sd Rec10","code_information":[{"code":"2800809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1156,"maximum":1156,"gross_charge":1445,"discounted_cash":1445,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1156}]}]},{"description":"Delta Xtend Locking Metaglene Screw","code_information":[{"code":"2800159","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1150,"maximum":1150,"gross_charge":1437,"discounted_cash":1437,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1150}]}]},{"description":"Synthes 1/3 Tubular Lcp Plate 8 Hole (C1","code_information":[{"code":"2800570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1148,"maximum":1148,"gross_charge":1435,"discounted_cash":1435,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1148}]}]},{"description":"Destruct B9 Lesion 1-15","code_information":[{"code":"1000089","type":"CDM"},{"code":"450","type":"RC"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1145,"gross_charge":1431,"discounted_cash":1431,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1145}]}]},{"description":"Arthrex Cann Screw 3.75 X 34mm Partially","code_information":[{"code":"2800081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1144,"maximum":1144,"gross_charge":1430,"discounted_cash":1430,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1144}]}]},{"description":"Arthrex Suture Anchor 3.5x10mm","code_information":[{"code":"2800092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1140,"maximum":1140,"gross_charge":1425,"discounted_cash":1425,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1140}]}]},{"description":"Treat Thumb Dislocation","code_information":[{"code":"8400198","type":"CDM"},{"code":"450","type":"RC"},{"code":"26641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1140,"maximum":1140,"gross_charge":1425,"discounted_cash":1425,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1140}]}]},{"description":"Rpr F/e/e/n/l/m 2.5 Cm/<","code_information":[{"code":"1000257","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1130,"maximum":1130,"gross_charge":1412,"discounted_cash":1412,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1130}]}]},{"description":"Treat Lower Jaw Fracture","code_information":[{"code":"8500156","type":"CDM"},{"code":"21451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1129,"maximum":1508,"gross_charge":1411,"discounted_cash":1411,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1129}]}]},{"description":"Ultrasound Guidance For Vascular Access","code_information":[{"code":"8401398","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1126,"maximum":1126,"gross_charge":1408,"discounted_cash":1408,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1126}]}]},{"description":"Us Soft Tissue Extr Nonvas","code_information":[{"code":"5100038","type":"CDM"},{"code":"402","type":"RC"},{"code":"76880","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1124,"maximum":1124,"gross_charge":1405,"discounted_cash":1405,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1124}]}]},{"description":"I & D Of Vulva/perineum","code_information":[{"code":"1000151","type":"CDM"},{"code":"450","type":"RC"},{"code":"56405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1122,"gross_charge":1402,"discounted_cash":1402,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1122}]}]},{"description":"Rpr S/n/ax/gen/trnk2.6-7.5cm","code_information":[{"code":"1000260","type":"CDM"},{"code":"450","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1119,"maximum":1119,"gross_charge":1399,"discounted_cash":1399,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1119},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1119},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1119}]}]},{"description":"Njx Anes Trigeminal Nrv Any Div/branch","code_information":[{"code":"8400320","type":"CDM"},{"code":"450","type":"RC"},{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1118,"gross_charge":1398,"discounted_cash":1398,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1118}]}]},{"description":"Cc E/m Critically Ill/injured 1st 30-74m","code_information":[{"code":"8500425","type":"CDM"},{"code":"99291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1118,"maximum":2300,"gross_charge":1397,"discounted_cash":1397,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1118},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Usg For Amniocentesis","code_information":[{"code":"5000179","type":"CDM"},{"code":"402","type":"RC"},{"code":"76946","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1117,"maximum":1117,"gross_charge":1396,"discounted_cash":1396,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1117},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1117},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1117}]}]},{"description":"X-Ray of lower back","code_information":[{"code":"8401463","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1114,"maximum":1114,"gross_charge":1392,"discounted_cash":1392,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1114},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1114},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1114}]}]},{"description":"Clsd Tx Prox Fibula/shaft Fract Wo/manip","code_information":[{"code":"8400218","type":"CDM"},{"code":"450","type":"RC"},{"code":"27780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1107,"gross_charge":1384,"discounted_cash":1384,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1107}]}]},{"description":"Wright 4.0 Countersink","code_information":[{"code":"2800698","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1106,"maximum":1106,"gross_charge":1383,"discounted_cash":1383,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1106}]}]},{"description":"Cholangiography Pancreatography Intraop","code_information":[{"code":"5000038","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1106,"maximum":1106,"gross_charge":1382,"discounted_cash":1382,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1106}]}]},{"description":"Clsd Tx Metacarpal Fract Single W/manip","code_information":[{"code":"8400196","type":"CDM"},{"code":"450","type":"RC"},{"code":"26605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1105,"gross_charge":1381,"discounted_cash":1381,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1105}]}]},{"description":"App Long Leg Splint Thigh-ankle/toes","code_information":[{"code":"1000113","type":"CDM"},{"code":"450","type":"RC"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1103,"maximum":1103,"gross_charge":1379,"discounted_cash":1379,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1103}]}]},{"description":"Usg/chorionic Villultrasonic Sampling","code_information":[{"code":"5000181","type":"CDM"},{"code":"402","type":"RC"},{"code":"76945","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1098,"maximum":1098,"gross_charge":1373,"discounted_cash":1373,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1098},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1098},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1098}]}]},{"description":"Insert Emergency Airway","code_information":[{"code":"1000181","type":"CDM"},{"code":"450","type":"RC"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1098,"gross_charge":1373,"discounted_cash":1373,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1098},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1098},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1098}]}]},{"description":"Depuy Synthes 2.7mm Va Lckng Screw","code_information":[{"code":"2800182","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1096,"maximum":1096,"gross_charge":1370,"discounted_cash":1370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1096}]}]},{"description":"Depuy Synthes 2.7mm Va Lckng Screw Slf-t","code_information":[{"code":"2800183","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1096,"maximum":1096,"gross_charge":1370,"discounted_cash":1370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1096}]}]},{"description":"Depuy Synthes 2.7mm Va Lckng Screw Slf-t","code_information":[{"code":"2800184","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1096,"maximum":1096,"gross_charge":1370,"discounted_cash":1370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1096}]}]},{"description":"Depuy Synthes 2.7mm Va Locking Screw Slf","code_information":[{"code":"2800186","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1096,"maximum":1096,"gross_charge":1370,"discounted_cash":1370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1096}]}]},{"description":"Dupuy 2.7mm Locking Screw 26mm","code_information":[{"code":"2800198","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1096,"maximum":1096,"gross_charge":1370,"discounted_cash":1370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1096}]}]},{"description":"Synthes 2.7 Locking Screw 22mm","code_information":[{"code":"2800580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1096,"maximum":1096,"gross_charge":1370,"discounted_cash":1370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1096}]}]},{"description":"Synthes 2.7 Va Locking Screw","code_information":[{"code":"2800581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1096,"maximum":1096,"gross_charge":1370,"discounted_cash":1370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1096}]}]},{"description":"Tcells Absolute Cd4&cd8 Count Incd Ratio","code_information":[{"code":"4000355","type":"CDM"},{"code":"300","type":"RC"},{"code":"86360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1096,"maximum":1096,"gross_charge":1370,"discounted_cash":1370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1096}]}]},{"description":"Xr Wrist Complete Rt","code_information":[{"code":"5000249","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1094,"maximum":1094,"gross_charge":1368,"discounted_cash":1368,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1094},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1094},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1094}]}]},{"description":"Xr Wrist Complete Lt","code_information":[{"code":"5000274","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1094,"maximum":1094,"gross_charge":1368,"discounted_cash":1368,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1094},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1094},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1094}]}]},{"description":"Xr Wrist Complete","code_information":[{"code":"5000322","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1094,"maximum":1094,"gross_charge":1368,"discounted_cash":1368,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1094},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1094},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1094}]}]},{"description":"Repair Nail Bed","code_information":[{"code":"8400092","type":"CDM"},{"code":"450","type":"RC"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1087,"gross_charge":1359,"discounted_cash":1359,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1087},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1087},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1087}]}]},{"description":"Repair Complex S/a/l 2.6 Cm-7.5 Cm","code_information":[{"code":"8400123","type":"CDM"},{"code":"450","type":"RC"},{"code":"13121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1087,"maximum":1232,"gross_charge":1359,"discounted_cash":1359,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1087},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1087},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1087}]}]},{"description":"Rep Cmp Eyelid/nose/ear/lip 2.6-7.5 Cm","code_information":[{"code":"8400129","type":"CDM"},{"code":"450","type":"RC"},{"code":"13152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1087,"maximum":1232,"gross_charge":1359,"discounted_cash":1359,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1087},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1087},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1087}]}]},{"description":"Clsd Tx Carpal Scaphoid Fract Wo/manip","code_information":[{"code":"8500183","type":"CDM"},{"code":"25622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1085,"maximum":1085,"gross_charge":1356,"discounted_cash":1356,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1085}]}]},{"description":"Stryker 2.5mm X20mm Fixos Cannulated Scr","code_information":[{"code":"2800433","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1082,"maximum":1082,"gross_charge":1353,"discounted_cash":1353,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1082}]}]},{"description":"Stryker Fix 2.5 Lag Screw 18mm","code_information":[{"code":"2800493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1082,"maximum":1082,"gross_charge":1353,"discounted_cash":1353,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1082}]}]},{"description":"Stryker S Fix Screw 2.5lg 16mm","code_information":[{"code":"2800542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1082,"maximum":1082,"gross_charge":1353,"discounted_cash":1353,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1082}]}]},{"description":"Stryker S-fix Screw 2.g Lg 22mm","code_information":[{"code":"2800543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1082,"maximum":1082,"gross_charge":1353,"discounted_cash":1353,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1082}]}]},{"description":"Stryker Snap Screw 2.0x12mm","code_information":[{"code":"2800548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1082,"maximum":1082,"gross_charge":1353,"discounted_cash":1353,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1082}]}]},{"description":"Xr Gi Tract Upper W/wo Delayed Img W/kub","code_information":[{"code":"8401519","type":"CDM"},{"code":"329","type":"RC"},{"code":"74241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1082,"maximum":1082,"gross_charge":1353,"discounted_cash":1353,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1082},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1082}]}]},{"description":"Stryker 5.5mm Titanium Intraline Anchor","code_information":[{"code":"2800444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1080,"maximum":1080,"gross_charge":1350,"discounted_cash":1350,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1080}]}]},{"description":"Anchor-4.5*28mm","code_information":[{"code":"2811252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1080,"maximum":1080,"gross_charge":1350,"discounted_cash":1350,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1080}]}]},{"description":"Clsd Tx Phalangeal Shaft Fract W/ma","code_information":[{"code":"8400202","type":"CDM"},{"code":"450","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1058,"maximum":1079,"gross_charge":1349,"discounted_cash":1349,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1079},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1079},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1079}]}]},{"description":"App Short Leg Cast Below Knee To Toes","code_information":[{"code":"1000117","type":"CDM"},{"code":"450","type":"RC"},{"code":"29405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1077,"maximum":1077,"gross_charge":1346,"discounted_cash":1346,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1077},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1077},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1077}]}]},{"description":"Repair Of Collateral Ligament Mcp/ip Jnt","code_information":[{"code":"8500194","type":"CDM"},{"code":"26540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1074,"maximum":1508,"gross_charge":1342,"discounted_cash":1342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1074},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1074},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1074}]}]},{"description":"Repair Of Finger Tendon","code_information":[{"code":"8400191","type":"CDM"},{"code":"450","type":"RC"},{"code":"26418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1070,"maximum":1508,"gross_charge":1338,"discounted_cash":1338,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1070},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1070},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1070}]}]},{"description":"Incision Of Anal Abscess","code_information":[{"code":"8400297","type":"CDM"},{"code":"450","type":"RC"},{"code":"46050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1068,"gross_charge":1335,"discounted_cash":1335,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1068}]}]},{"description":"Anosc Rmvl Fb","code_information":[{"code":"8400301","type":"CDM"},{"code":"450","type":"RC"},{"code":"46608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1068,"gross_charge":1335,"discounted_cash":1335,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1068},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1068}]}]},{"description":"Clsd Tx Proximal Humeral Fract Wo/manip","code_information":[{"code":"8400164","type":"CDM"},{"code":"450","type":"RC"},{"code":"23600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Tx Closed Elbow Dislocation Wo/anes","code_information":[{"code":"8400171","type":"CDM"},{"code":"450","type":"RC"},{"code":"24600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Radial Head Sublux Elbow W/manip","code_information":[{"code":"8400172","type":"CDM"},{"code":"450","type":"RC"},{"code":"24640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1062,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Ulnar Fract Proximal End Wo/m","code_information":[{"code":"8400175","type":"CDM"},{"code":"450","type":"RC"},{"code":"24670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Ulnar Shaft Fracture W/manip","code_information":[{"code":"8400178","type":"CDM"},{"code":"450","type":"RC"},{"code":"25535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Distal Rad Fract/epiphyseal Sep","code_information":[{"code":"8400181","type":"CDM"},{"code":"450","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Carpal Bone Fract Wo/manipulat","code_information":[{"code":"8400184","type":"CDM"},{"code":"450","type":"RC"},{"code":"25630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Radio/intrcrpl Dslc 1/> Bone W/m","code_information":[{"code":"8400186","type":"CDM"},{"code":"450","type":"RC"},{"code":"25660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Mcp Disloc Sngl W/man Wo/anes","code_information":[{"code":"8400199","type":"CDM"},{"code":"450","type":"RC"},{"code":"26700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1062,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Distal Phalangeal Fract Wo Manip","code_information":[{"code":"8400204","type":"CDM"},{"code":"450","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1062,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Distal Phalangeal Fract W/manip","code_information":[{"code":"8400205","type":"CDM"},{"code":"450","type":"RC"},{"code":"26755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1062,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Ip Joint Disloc Sng W/manp Wo/an","code_information":[{"code":"8400206","type":"CDM"},{"code":"450","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1062,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Treatment Of Thigh Fracture","code_information":[{"code":"8400209","type":"CDM"},{"code":"450","type":"RC"},{"code":"27500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Patellar Dislocation Wo Anes","code_information":[{"code":"8400213","type":"CDM"},{"code":"450","type":"RC"},{"code":"27560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Tibial Shaft Fract Wo Manip","code_information":[{"code":"8400214","type":"CDM"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Fract Wt Bear Artclr Prt Dst Tib","code_information":[{"code":"8400222","type":"CDM"},{"code":"450","type":"RC"},{"code":"27824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Clsd Tx Ankle Dislocation Wo Anes","code_information":[{"code":"8400224","type":"CDM"},{"code":"450","type":"RC"},{"code":"27840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1062,"gross_charge":1328,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Xr Cervical Spine Complete","code_information":[{"code":"5000282","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1062,"maximum":1062,"gross_charge":1327,"discounted_cash":1327,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"X Ray Spine Cervical 4 Or 5 Views","code_information":[{"code":"8401456","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1062,"maximum":1062,"gross_charge":1327,"discounted_cash":1327,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1062},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1062}]}]},{"description":"Ophthalmic Us Diagnostic B-scan","code_information":[{"code":"8401372","type":"CDM"},{"code":"402","type":"RC"},{"code":"76512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056,"maximum":1056,"gross_charge":1320,"discounted_cash":1320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1056}]}]},{"description":"Xr Hip Bilat Limited 2 Views","code_information":[{"code":"5000226","type":"CDM"},{"code":"329","type":"RC"},{"code":"73521","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1054,"maximum":1054,"gross_charge":1318,"discounted_cash":1318,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1054}]}]},{"description":"Xr Hips Bilateral W/pelvis 2 Views","code_information":[{"code":"8401493","type":"CDM"},{"code":"329","type":"RC"},{"code":"73521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1054,"maximum":1054,"gross_charge":1318,"discounted_cash":1318,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1054}]}]},{"description":"Inj Anes Agent Greater Occipital Nerve","code_information":[{"code":"1000161","type":"CDM"},{"code":"450","type":"RC"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Njx Anes Facial Nrv","code_information":[{"code":"8400321","type":"CDM"},{"code":"450","type":"RC"},{"code":"64402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"N Block Inj Occipital","code_information":[{"code":"8400322","type":"CDM"},{"code":"450","type":"RC"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"3.5 Lckng Screw Slf Tpng W/sd Rec 55","code_information":[{"code":"2800009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Synthes 3.5 Clocking Screw Slf-tapping 3","code_information":[{"code":"2800587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Synthes 3.5 Locking Screw 36mm","code_information":[{"code":"2800597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Synthes 3.5mm Locking Screw 38mm","code_information":[{"code":"2800604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Synthes 3.5mm Locking Screw Slf-tpng W/s","code_information":[{"code":"2800605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Synthes 3.5mm Locking Slf-tpng W/stardri","code_information":[{"code":"2800607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Synthes Synthes 3.9mm Locking Screw 24mm","code_information":[{"code":"2800646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Sythes 3.5 Locking Screw Slf-tpng W/star","code_information":[{"code":"2800656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1052,"maximum":1052,"gross_charge":1315,"discounted_cash":1315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1052},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"Us Soft Tissues Head&neck  Rt W/img","code_information":[{"code":"8401373","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1047,"maximum":1047,"gross_charge":1309,"discounted_cash":1309,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1047},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1047},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1047}]}]},{"description":"Incision&drain Abscess Comp Multiple","code_information":[{"code":"8400069","type":"CDM"},{"code":"450","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1046,"gross_charge":1307,"discounted_cash":1307,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1046},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1046},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1046}]}]},{"description":"Clsd Tx Distal Rad Fract/epiphyseal Sep","code_information":[{"code":"8500182","type":"CDM"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1045,"maximum":1232,"gross_charge":1306,"discounted_cash":1306,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1045}]}]},{"description":"Apply Short Leg Cast","code_information":[{"code":"1000118","type":"CDM"},{"code":"450","type":"RC"},{"code":"29425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1043,"gross_charge":1304,"discounted_cash":1304,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Stryker Locking Screw 3.0 X 14 Mm","code_information":[{"code":"2800511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1043,"gross_charge":1304,"discounted_cash":1304,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Stryker Locking Screw T8 30.x18mm","code_information":[{"code":"2800532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1043,"gross_charge":1304,"discounted_cash":1304,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Application Cast Finger Eg Contracture","code_information":[{"code":"1000123","type":"CDM"},{"code":"450","type":"RC"},{"code":"29086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1043,"gross_charge":1304,"discounted_cash":1304,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Clsd Tx Distal Fibular Fract Wo Manip","code_information":[{"code":"8400219","type":"CDM"},{"code":"450","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1042,"gross_charge":1303,"discounted_cash":1303,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1042}]}]},{"description":"Fluoro Guided Needle Placement","code_information":[{"code":"5000082","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1042,"maximum":1042,"gross_charge":1302,"discounted_cash":1302,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1042}]}]},{"description":"Ultrasound Scrotum And Contents","code_information":[{"code":"8401395","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1042,"maximum":1042,"gross_charge":1302,"discounted_cash":1302,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1042}]}]},{"description":"Acumed 10mm X 3.5 Locking Screw","code_information":[{"code":"2800023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1036,"maximum":1036,"gross_charge":1295,"discounted_cash":1295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1036}]}]},{"description":"Acumed 16 Screw","code_information":[{"code":"2800774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1036,"maximum":1036,"gross_charge":1295,"discounted_cash":1295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1036}]}]},{"description":"Acumed 18 Screw","code_information":[{"code":"2800775","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1036,"maximum":1036,"gross_charge":1295,"discounted_cash":1295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1036}]}]},{"description":"Acumed 2.7x20mm Lckng Screw","code_information":[{"code":"2800798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1036,"maximum":1036,"gross_charge":1295,"discounted_cash":1295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1036}]}]},{"description":"Acumed 3.5x20mm Lckng Screw","code_information":[{"code":"2800799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1036,"maximum":1036,"gross_charge":1295,"discounted_cash":1295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1036}]}]},{"description":"Acumed 3.5x22mm Lckng Screw","code_information":[{"code":"2800800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1036,"maximum":1036,"gross_charge":1295,"discounted_cash":1295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1036}]}]},{"description":"Acumed 3.5x40mm Lckng Screw","code_information":[{"code":"2800801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1036,"maximum":1036,"gross_charge":1295,"discounted_cash":1295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1036}]}]},{"description":"Acumed 3.0x14 Lkng Hexalobe Screw","code_information":[{"code":"2800812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1036,"maximum":1036,"gross_charge":1295,"discounted_cash":1295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1036}]}]},{"description":"Nevro Lead Anchor Kit L8699","code_information":[{"code":"2800333","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1032,"maximum":1032,"gross_charge":1290,"discounted_cash":1290,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1032},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1032}]}]},{"description":"Mech Rem Obstr Mater Central Venous Dev","code_information":[{"code":"5000110","type":"CDM"},{"code":"320","type":"RC"},{"code":"75902","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1028,"maximum":1028,"gross_charge":1285,"discounted_cash":1285,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1028}]}]},{"description":"Reset Dislocated Jaw","code_information":[{"code":"1000071","type":"CDM"},{"code":"450","type":"RC"},{"code":"21480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1025,"gross_charge":1281,"discounted_cash":1281,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1025},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1025},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1025}]}]},{"description":"Ct Of Heart  Wo","code_information":[{"code":"5000326","type":"CDM"},{"code":"320","type":"RC"},{"code":"75571","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1025,"maximum":1025,"gross_charge":1281,"discounted_cash":1281,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1025},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1025},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1025}]}]},{"description":"3.5mm Variable Angle Locking Screw 38mm","code_information":[{"code":"2800014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1024,"maximum":1024,"gross_charge":1280,"discounted_cash":1280,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1024},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1024},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1024}]}]},{"description":"Depuy Synthes 1.5 Va Lckng Screw Slf Tpn","code_information":[{"code":"2800174","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1024,"maximum":1024,"gross_charge":1280,"discounted_cash":1280,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1024},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1024},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1024}]}]},{"description":"Inj Anes Agent Brachial Plexus Single","code_information":[{"code":"1000158","type":"CDM"},{"code":"450","type":"RC"},{"code":"64415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1022,"gross_charge":1278,"discounted_cash":1278,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1022}]}]},{"description":"N Block Inj Brachial Plexus","code_information":[{"code":"8400324","type":"CDM"},{"code":"450","type":"RC"},{"code":"64415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1022,"gross_charge":1278,"discounted_cash":1278,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1022}]}]},{"description":"N Block Inj Pudendal","code_information":[{"code":"8400327","type":"CDM"},{"code":"450","type":"RC"},{"code":"64430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1022,"gross_charge":1278,"discounted_cash":1278,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1022}]}]},{"description":"App Cast Figure Of Eight","code_information":[{"code":"1000122","type":"CDM"},{"code":"450","type":"RC"},{"code":"29049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1020,"maximum":1020,"gross_charge":1275,"discounted_cash":1275,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1020},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1020},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1020}]}]},{"description":"App Short Arm Splint Dynamic","code_information":[{"code":"1000115","type":"CDM"},{"code":"450","type":"RC"},{"code":"29126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1014,"maximum":1014,"gross_charge":1268,"discounted_cash":1268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1014}]}]},{"description":"Inj Anes Agent Other Periph Nrv/brnch","code_information":[{"code":"1000162","type":"CDM"},{"code":"450","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1014,"gross_charge":1268,"discounted_cash":1268,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1014}]}]},{"description":"Nerve Block Anes Other Prph Nrv/branch","code_information":[{"code":"8400328","type":"CDM"},{"code":"450","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1014,"gross_charge":1268,"discounted_cash":1268,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1014},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1014}]}]},{"description":"Psu Measure Post-voiding Us Non-imaging","code_information":[{"code":"600008","type":"CDM"},{"code":"220","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Us Urine Capacity Measure","code_information":[{"code":"1000187","type":"CDM"},{"code":"450","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Us Urine Capacity Measure","code_information":[{"code":"2201834","type":"CDM"},{"code":"761","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Dxa Bone Density/peripheral","code_information":[{"code":"5000069","type":"CDM"},{"code":"329","type":"RC"},{"code":"77081","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Orthopantogram","code_information":[{"code":"5000123","type":"CDM"},{"code":"329","type":"RC"},{"code":"70355","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Radiographic Procedure","code_information":[{"code":"5000188","type":"CDM"},{"code":"320","type":"RC"},{"code":"76499","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Femur 1 View","code_information":[{"code":"5000213","type":"CDM"},{"code":"329","type":"RC"},{"code":"73551","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Femur 2 Views Lt","code_information":[{"code":"5000221","type":"CDM"},{"code":"329","type":"RC"},{"code":"73552","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Ankle Complete Rt","code_information":[{"code":"5000227","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Ankle Limited 2 Views Rt","code_information":[{"code":"5000228","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Elbow Limited 2 Views Rt","code_information":[{"code":"5000231","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Femur 2 Views Rt","code_information":[{"code":"5000232","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr L-spine Comp With Flex/ext","code_information":[{"code":"5000235","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Pelvis 1-2 Views","code_information":[{"code":"5000241","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Sacroiliac Joints 3+ Views","code_information":[{"code":"5000243","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Sacroiliac Joints Limited","code_information":[{"code":"5000244","type":"CDM"},{"code":"320","type":"RC"},{"code":"72200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Sacrum/coccyx 2+ Views","code_information":[{"code":"5000245","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Shoulder Complete Lt","code_information":[{"code":"5000246","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"TCLT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCLT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Tibia/fibula Complete Rt","code_information":[{"code":"5000247","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Wrist Limited 2 Views Rt","code_information":[{"code":"5000250","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Ankle Complete Lt","code_information":[{"code":"5000256","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Ankle Limited 2 Views Lt","code_information":[{"code":"5000257","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Elbow Limited 2 Views Lt","code_information":[{"code":"5000260","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Foot Limited 2 Views Lt","code_information":[{"code":"5000263","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Ribs Unilat 2 Views Lt","code_information":[{"code":"5000270","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Tibia/fibula Complete Lt","code_information":[{"code":"5000272","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Wrist Limited 2 Views Lt","code_information":[{"code":"5000275","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr  Ankle Complete","code_information":[{"code":"5000278","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Ankle Limited 2 Views","code_information":[{"code":"5000279","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Elbow Limited 2 Views","code_information":[{"code":"5000286","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Foot Limited 2 Views Rt","code_information":[{"code":"5000290","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Lumbar Spine Comp With Flex/ext","code_information":[{"code":"5000297","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Pelvis Complete","code_information":[{"code":"5000303","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Ribs Unilat 2 Views Rt","code_information":[{"code":"5000305","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Sacroiliac Joints 3+ Views","code_information":[{"code":"5000307","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Sacroiliac Joints Limited","code_information":[{"code":"5000308","type":"CDM"},{"code":"320","type":"RC"},{"code":"72200","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Sacrum/coccyx 2+ Views","code_information":[{"code":"5000309","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Shoulder Complete Rt","code_information":[{"code":"5000310","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"TCRT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCRT"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Sinus/paranasal Complete","code_information":[{"code":"5000311","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Sinus/paranasal Limited","code_information":[{"code":"5000312","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Skull Complete","code_information":[{"code":"5000313","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Tibia/fibula Complete","code_information":[{"code":"5000320","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Wrist Limited 2 Views","code_information":[{"code":"5000323","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Xr Shoulder 1 View","code_information":[{"code":"5000324","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Us Bladder Post Viod","code_information":[{"code":"5100066","type":"CDM"},{"code":"402","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Us- Bladder","code_information":[{"code":"5100068","type":"CDM"},{"code":"761","type":"RC"},{"code":"51798","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Ct Bone Density Axial","code_information":[{"code":"5200011","type":"CDM"},{"code":"352","type":"RC"},{"code":"77078","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Computed Tomography Proc Diag Intervent","code_information":[{"code":"5200046","type":"CDM"},{"code":"352","type":"RC"},{"code":"76497","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1010,"maximum":1010,"gross_charge":1262,"discounted_cash":1262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1010},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1010}]}]},{"description":"Synthes 2.7mm/3.5mm Fibula Plate","code_information":[{"code":"2800740","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1009,"maximum":1009,"gross_charge":1261,"discounted_cash":1261,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1009},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1009},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1009}]}]},{"description":"Morpheus Valum 12cc","code_information":[{"code":"2800327","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1008,"maximum":1008,"gross_charge":1260,"discounted_cash":1260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1008}]}]},{"description":"Special Teletx Port Plan","code_information":[{"code":"5000156","type":"CDM"},{"code":"329","type":"RC"},{"code":"77321","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1008,"maximum":1008,"gross_charge":1260,"discounted_cash":1260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1008}]}]},{"description":"Clsd Tx Radial Head/neck Fract Wo/manip","code_information":[{"code":"8400173","type":"CDM"},{"code":"450","type":"RC"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":1006,"gross_charge":1258,"discounted_cash":1258,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1006},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1006},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1006}]}]},{"description":"Glucagon 1mg","code_information":[{"code":"3000110","type":"CDM"},{"code":"636","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1001,"maximum":1001,"gross_charge":1251,"discounted_cash":1251,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1001},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1001},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1001}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Evolution Medical 3x5x12mm Screw","code_information":[{"code":"2800211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"In2bones One Thrid Tubular Plate 6hole","code_information":[{"code":"2800232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Spinal Elements 12mm Screw","code_information":[{"code":"2800371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Spinal Elements 14 Mm Screw","code_information":[{"code":"2800372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Spinal Elements 14mm Screws","code_information":[{"code":"2800373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Spinal Elements 16mm Screw","code_information":[{"code":"2800377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Spineart 5.0 X 25mm Screw","code_information":[{"code":"2800410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Spineart 5.0x30mm Screw","code_information":[{"code":"2800411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Zavation 16mm Rescue Screw","code_information":[{"code":"2800714","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Zavation 16mm Screw Vsd","code_information":[{"code":"2800715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Zavation 4.0 X 14mm St Screws","code_information":[{"code":"2800719","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Arthrex Laserjet Wedged Plate","code_information":[{"code":"2800750","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1000,"gross_charge":1250,"discounted_cash":1250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Removal Of Nail Plate 1st","code_information":[{"code":"1000008","type":"CDM"},{"code":"450","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":999,"gross_charge":1249,"discounted_cash":1249,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":999},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":999},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":999}]}]},{"description":"Ultrasound pelvis through vagina","code_information":[{"code":"5100063","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":998,"maximum":998,"gross_charge":1248,"discounted_cash":1248,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":998}]}]},{"description":"Ultrasound pelvis through vagina","code_information":[{"code":"8401392","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":998,"maximum":998,"gross_charge":1248,"discounted_cash":1248,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":998}]}]},{"description":"Pt Eval Mod Compl","code_information":[{"code":"6100027","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":997,"gross_charge":1246,"discounted_cash":1246,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Eval Mod Compl","code_information":[{"code":"6100028","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":997,"gross_charge":1246,"discounted_cash":1246,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Eval Low High","code_information":[{"code":"6100029","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":997,"gross_charge":1246,"discounted_cash":1246,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Eval Low High","code_information":[{"code":"6100030","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":997,"gross_charge":1246,"discounted_cash":1246,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Tenotomy Flexor Palm Open Each Tendon","code_information":[{"code":"8500192","type":"CDM"},{"code":"26450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":994,"maximum":1232,"gross_charge":1242,"discounted_cash":1242,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":994},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":994},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":994}]}]},{"description":"Control Of Nosebleed","code_information":[{"code":"1000079","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":984,"gross_charge":1230,"discounted_cash":1230,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":984},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":984},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":984}]}]},{"description":"Fluoro Guided & Localization Needle Esi","code_information":[{"code":"5000080","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":983,"maximum":983,"gross_charge":1229,"discounted_cash":1229,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":983},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":983},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":983}]}]},{"description":"Endoscopic Catheterization","code_information":[{"code":"5000075","type":"CDM"},{"code":"329","type":"RC"},{"code":"74328","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":982,"maximum":982,"gross_charge":1228,"discounted_cash":1228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":982},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":982},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":982}]}]},{"description":"Wright 6.0 Countersink","code_information":[{"code":"2800699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":982,"maximum":982,"gross_charge":1227,"discounted_cash":1227,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":982},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":982},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":982}]}]},{"description":"App Cast Hand And Lower Forearm Gauntlet","code_information":[{"code":"1000124","type":"CDM"},{"code":"450","type":"RC"},{"code":"29085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":980,"maximum":980,"gross_charge":1225,"discounted_cash":1225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":980}]}]},{"description":"Clsd Tx Shldr Dislocation W/manip Wo/ans","code_information":[{"code":"8400166","type":"CDM"},{"code":"450","type":"RC"},{"code":"23650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":980,"gross_charge":1225,"discounted_cash":1225,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":980},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":980}]}]},{"description":"Wright Locking Screw T8 3.5 X 22mm","code_information":[{"code":"2800704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":976,"maximum":976,"gross_charge":1220,"discounted_cash":1220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":976},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":976},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":976}]}]},{"description":"Removal Intrauterine Device Iud","code_information":[{"code":"1000215","type":"CDM"},{"code":"450","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":975,"gross_charge":1219,"discounted_cash":1219,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":975},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":975}]}]},{"description":"Set Radiation Therapy Field","code_information":[{"code":"5000169","type":"CDM"},{"code":"329","type":"RC"},{"code":"77263","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":974,"maximum":974,"gross_charge":1218,"discounted_cash":1218,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":974}]}]},{"description":"Closed Tx Clavicular Fracture W/o Manip","code_information":[{"code":"8400161","type":"CDM"},{"code":"450","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":974,"gross_charge":1217,"discounted_cash":1217,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":974}]}]},{"description":"Treat Hip Dislocation","code_information":[{"code":"8400207","type":"CDM"},{"code":"450","type":"RC"},{"code":"27250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":974,"gross_charge":1217,"discounted_cash":1217,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":974}]}]},{"description":"Inj Anes Agent Stellate Ganglion","code_information":[{"code":"1000165","type":"CDM"},{"code":"450","type":"RC"},{"code":"64510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":972,"gross_charge":1215,"discounted_cash":1215,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":972},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":972},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":972}]}]},{"description":"N Block Stellate Ganglion","code_information":[{"code":"8400331","type":"CDM"},{"code":"450","type":"RC"},{"code":"64510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":972,"gross_charge":1215,"discounted_cash":1215,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":972},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":972},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":972}]}]},{"description":"Acumed 12mm Locking Screw","code_information":[{"code":"2800024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":968,"maximum":968,"gross_charge":1210,"discounted_cash":1210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":968}]}]},{"description":"Acumed 14mm Locking Screw","code_information":[{"code":"2800026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":968,"maximum":968,"gross_charge":1210,"discounted_cash":1210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":968}]}]},{"description":"Acumed 18mm X 2.7mm Locking Screw","code_information":[{"code":"2800031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":968,"maximum":968,"gross_charge":1210,"discounted_cash":1210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":968}]}]},{"description":"Acumed 8mm Locking Screw","code_information":[{"code":"2800047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":968,"maximum":968,"gross_charge":1210,"discounted_cash":1210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":968}]}]},{"description":"Dupuy 2.7mm Locking Screw 28mm","code_information":[{"code":"2800199","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":964,"maximum":964,"gross_charge":1205,"discounted_cash":1205,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":964},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":964},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":964}]}]},{"description":"Stryker Micro Cannulated Screw 2.0 X 14m","code_information":[{"code":"2800534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":963,"maximum":963,"gross_charge":1204,"discounted_cash":1204,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":963},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":963},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":963}]}]},{"description":"Fluoroscopy <1 Hr Phys/qhp","code_information":[{"code":"5000083","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":961,"maximum":961,"gross_charge":1201,"discounted_cash":1201,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":961}]}]},{"description":"Ligation Div &/Or Exc Varicose Vein Clst","code_information":[{"code":"8500280","type":"CDM"},{"code":"37785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":955,"maximum":1232,"gross_charge":1194,"discounted_cash":1194,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":955}]}]},{"description":"Clsd Tx Metacarpal Fract Single Wo/manip","code_information":[{"code":"8400195","type":"CDM"},{"code":"450","type":"RC"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":954,"maximum":954,"gross_charge":1192,"discounted_cash":1192,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":954}]}]},{"description":"Clsd Tx Phalangeal Shaft Fract Wo","code_information":[{"code":"8400201","type":"CDM"},{"code":"450","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":954,"gross_charge":1192,"discounted_cash":1192,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":954}]}]},{"description":"Us Dup Scn Extracranial Art Unilat/lmtd","code_information":[{"code":"8401400","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":1185,"discounted_cash":1185,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":948},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Dup Scn Extracranial Art Comp Bilat","code_information":[{"code":"8401399","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":1184,"discounted_cash":1184,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Tcd Std Icra Art Compl Std","code_information":[{"code":"8401401","type":"CDM"},{"code":"921","type":"RC"},{"code":"93886","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":1184,"discounted_cash":1184,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Ob Detailed Addl Fetus","code_information":[{"code":"5100044","type":"CDM"},{"code":"402","type":"RC"},{"code":"76812","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":946,"maximum":946,"gross_charge":1182,"discounted_cash":1182,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":946},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":946},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":946}]}]},{"description":"Bone Marrow Imaging; Whole Body","code_information":[{"code":"5210001","type":"CDM"},{"code":"352","type":"RC"},{"code":"78104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":943,"maximum":943,"gross_charge":1179,"discounted_cash":1179,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":943},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":943},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":943}]}]},{"description":"Arferencethrex Bio-comp Interference Scr","code_information":[{"code":"2800062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":940,"maximum":940,"gross_charge":1175,"discounted_cash":1175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":940}]}]},{"description":"Arthrex Bio-comp Interscrew W/disp","code_information":[{"code":"2800077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":940,"maximum":940,"gross_charge":1175,"discounted_cash":1175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":940}]}]},{"description":"Arthrex Biocomposite Inter-ference Screw","code_information":[{"code":"2800078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":940,"maximum":940,"gross_charge":1175,"discounted_cash":1175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":940}]}]},{"description":"Arthrex Interference Screw","code_information":[{"code":"2800087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":940,"maximum":940,"gross_charge":1175,"discounted_cash":1175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":940}]}]},{"description":"Clsd Tx Supra/transcondylar Humeral Frct","code_information":[{"code":"8500170","type":"CDM"},{"code":"24535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":938,"gross_charge":1173,"discounted_cash":1173,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":938}]}]},{"description":"Xr Elbow Complete Rt","code_information":[{"code":"5000230","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":938,"maximum":938,"gross_charge":1172,"discounted_cash":1172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":938}]}]},{"description":"Xr Elbow Complete Lt","code_information":[{"code":"5000259","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":938,"maximum":938,"gross_charge":1172,"discounted_cash":1172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":938}]}]},{"description":"Xr Elbow Complete","code_information":[{"code":"5000285","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":938,"maximum":938,"gross_charge":1172,"discounted_cash":1172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":938}]}]},{"description":"X Ray Elbow Complete Minimum Of 3 Views","code_information":[{"code":"8401480","type":"CDM"},{"code":"359","type":"RC"},{"code":"73080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":938,"maximum":938,"gross_charge":1172,"discounted_cash":1172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":938}]}]},{"description":"Repair Inter F/e/e/n/l/m&/muc 5.1-7.5 Cm","code_information":[{"code":"8400117","type":"CDM"},{"code":"450","type":"RC"},{"code":"12053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":936,"gross_charge":1170,"discounted_cash":1170,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":936}]}]},{"description":"Repair Inter F/e/e/n/l/m&/muc 7.6-12.5cm","code_information":[{"code":"8400118","type":"CDM"},{"code":"450","type":"RC"},{"code":"12054","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":936,"maximum":1058,"gross_charge":1170,"discounted_cash":1170,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":936},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":936}]}]},{"description":"Electrocardiograph Monitoring For 24 Hrs","code_information":[{"code":"4200010","type":"CDM"},{"code":"730","type":"RC"},{"code":"93224","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":934,"gross_charge":1167,"discounted_cash":1167,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Set Radiation Therapy Field","code_information":[{"code":"5000171","type":"CDM"},{"code":"329","type":"RC"},{"code":"77261","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":932,"maximum":932,"gross_charge":1165,"discounted_cash":1165,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":932},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":932},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":932}]}]},{"description":"Xr Spine Lumbosacral Comp Bend Mn 6 V","code_information":[{"code":"8401464","type":"CDM"},{"code":"359","type":"RC"},{"code":"72114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":928,"maximum":928,"gross_charge":1160,"discounted_cash":1160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":928},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":928},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":928}]}]},{"description":"H Pylori Blood Test Analysis For Urease","code_information":[{"code":"4000171","type":"CDM"},{"code":"300","type":"RC"},{"code":"83009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":926,"maximum":926,"gross_charge":1157,"discounted_cash":1157,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":926},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":926},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":926}]}]},{"description":"Rpr S/n/ax/gen/trnk 2.5cm/<","code_information":[{"code":"1000263","type":"CDM"},{"code":"450","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":926,"gross_charge":1157,"discounted_cash":1157,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":926},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":926},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":926}]}]},{"description":"Acumed 12mm X 2.3mm Screw","code_information":[{"code":"2800025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":924,"gross_charge":1155,"discounted_cash":1155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":924}]}]},{"description":"Kyphon Hv-r Bone Coment","code_information":[{"code":"2800258","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":924,"gross_charge":1155,"discounted_cash":1155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":924}]}]},{"description":"Acumed 2.3x10mm Lckng Screw","code_information":[{"code":"2800803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":924,"gross_charge":1155,"discounted_cash":1155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":924}]}]},{"description":"Acumed 2.3x8mm Lckng Screw","code_information":[{"code":"2800804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":924,"gross_charge":1155,"discounted_cash":1155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":924}]}]},{"description":"Xr Hip Unilat Complete","code_information":[{"code":"5000223","type":"CDM"},{"code":"329","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":924,"maximum":924,"gross_charge":1155,"discounted_cash":1155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":924}]}]},{"description":"Us Low Ext Study","code_information":[{"code":"8401403","type":"CDM"},{"code":"921","type":"RC"},{"code":"93925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":1151,"discounted_cash":1151,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Dop Dp-scn Lxtr Art/artl Bpgs Uni/lmt","code_information":[{"code":"8401404","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":1151,"discounted_cash":1151,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Division Scalenus Anticus Resct Cerv Rib","code_information":[{"code":"8500159","type":"CDM"},{"code":"21705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":1665,"gross_charge":1151,"discounted_cash":1151,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":921}]}]},{"description":"Tracheostomy Planned Spx","code_information":[{"code":"8500266","type":"CDM"},{"code":"31600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":918,"maximum":1058,"gross_charge":1147,"discounted_cash":1147,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":918},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":918},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":918}]}]},{"description":"Gi Pathogen Panel","code_information":[{"code":"4000229","type":"CDM"},{"code":"300","type":"RC"},{"code":"87507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":914,"maximum":914,"gross_charge":1143,"discounted_cash":1143,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":914}]}]},{"description":"Infectious Agent Detection Nucleic Acid","code_information":[{"code":"8400757","type":"CDM"},{"code":"300","type":"RC"},{"code":"87507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":914,"maximum":914,"gross_charge":1143,"discounted_cash":1143,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":914}]}]},{"description":"Stryker 4x4cm Allowrap Ds (Per Sqcm)","code_information":[{"code":"2800441","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":912,"maximum":912,"gross_charge":1140,"discounted_cash":1140,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":912},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":912},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":912}]}]},{"description":"X Ray Spine Cervical 6 Or More Views","code_information":[{"code":"8401457","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":910,"maximum":910,"gross_charge":1138,"discounted_cash":1138,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":910},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":910},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":910}]}]},{"description":"Us Arterial Dop Upper Ext Unilat Rt","code_information":[{"code":"5100067","type":"CDM"},{"code":"402","type":"RC"},{"code":"93931","type":"CPT","modifier":"TCRT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCRT"],"minimum":910,"maximum":910,"gross_charge":1137,"discounted_cash":1137,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":910},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":910},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":910}]}]},{"description":"Anis Micro 3.0 Screw 16mm","code_information":[{"code":"2800061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":909,"maximum":909,"gross_charge":1136,"discounted_cash":1136,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":909}]}]},{"description":"Stryker Micro Cannulated Screw 3.0 17mm","code_information":[{"code":"2800536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":909,"maximum":909,"gross_charge":1136,"discounted_cash":1136,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":909},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":909}]}]},{"description":"Repair Intermediate S/a/t/e 12.6-20.0cm","code_information":[{"code":"8400110","type":"CDM"},{"code":"450","type":"RC"},{"code":"12035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":902,"maximum":1058,"gross_charge":1128,"discounted_cash":1128,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":902},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":902}]}]},{"description":"Synthes 2.7mm Va Locking Screw Slf-tpng","code_information":[{"code":"2800583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":900,"maximum":900,"gross_charge":1125,"discounted_cash":1125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":900}]}]},{"description":"Trilliant 3.5 X 18mm Arsenal Screw","code_information":[{"code":"2800684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":900,"maximum":900,"gross_charge":1125,"discounted_cash":1125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":900}]}]},{"description":"S&n Rg Dialiate 5.5","code_information":[{"code":"2800791","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":900,"maximum":900,"gross_charge":1125,"discounted_cash":1125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":900}]}]},{"description":"Radiation Treatment Delivery","code_information":[{"code":"5000143","type":"CDM"},{"code":"320","type":"RC"},{"code":"77401","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":898,"maximum":898,"gross_charge":1122,"discounted_cash":1122,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":898},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":898}]}]},{"description":"Removal Skin Tags Mult Fibrocut","code_information":[{"code":"1000216","type":"CDM"},{"code":"450","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":896,"maximum":924,"gross_charge":1120,"discounted_cash":1120,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":896},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":896},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":896}]}]},{"description":"Us Breasts Real Time With Image Doc","code_information":[{"code":"5100036","type":"CDM"},{"code":"402","type":"RC"},{"code":"76645","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":893,"maximum":893,"gross_charge":1116,"discounted_cash":1116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":893},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":893},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":893}]}]},{"description":"Inj Anes Agent Cervical Plexus","code_information":[{"code":"1000159","type":"CDM"},{"code":"450","type":"RC"},{"code":"64413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":892,"maximum":892,"gross_charge":1115,"discounted_cash":1115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":892}]}]},{"description":"N Block Inj Cervical Plexus","code_information":[{"code":"8400323","type":"CDM"},{"code":"450","type":"RC"},{"code":"64413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":892,"maximum":892,"gross_charge":1115,"discounted_cash":1115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":892}]}]},{"description":"N Block Inj Cervical Plexus","code_information":[{"code":"8443230","type":"CDM"},{"code":"450","type":"RC"},{"code":"64999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":892,"maximum":924,"gross_charge":1115,"discounted_cash":1115,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":892},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":892}]}]},{"description":"X Ray Knee Complete 4 Or More Views","code_information":[{"code":"8401501","type":"CDM"},{"code":"329","type":"RC"},{"code":"73564","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":891,"maximum":891,"gross_charge":1114,"discounted_cash":1114,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":891}]}]},{"description":"Simple Repair F/e/e/n/l/m 7.6cm-12.5cm","code_information":[{"code":"8400103","type":"CDM"},{"code":"450","type":"RC"},{"code":"12015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":890,"maximum":924,"gross_charge":1113,"discounted_cash":1113,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":890}]}]},{"description":"Us Bone Density Measure","code_information":[{"code":"5100025","type":"CDM"},{"code":"402","type":"RC"},{"code":"76977","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":890,"maximum":890,"gross_charge":1113,"discounted_cash":1113,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":890}]}]},{"description":"Njx Aa&/strd Sprscap Nrv","code_information":[{"code":"600003","type":"CDM"},{"code":"220","type":"RC"},{"code":"64418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":890,"maximum":924,"gross_charge":1112,"discounted_cash":1112,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":890}]}]},{"description":"Inj Tc-99m Rbc Ultra Tag","code_information":[{"code":"3060823","type":"CDM"},{"code":"636","type":"RC"},{"code":"50419022001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":885,"maximum":885,"gross_charge":1106,"discounted_cash":1106,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":885},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":885},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":885}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Us Preg Uterus Rt W/img Doc F-up","code_information":[{"code":"8401390","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":884,"maximum":884,"gross_charge":1105,"discounted_cash":1105,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":884}]}]},{"description":"Removal/revision Of Cast","code_information":[{"code":"1000218","type":"CDM"},{"code":"450","type":"RC"},{"code":"29705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":884,"maximum":884,"gross_charge":1105,"discounted_cash":1105,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":884}]}]},{"description":"Clsd Tx Metatarsal Fract Wo Manip Each","code_information":[{"code":"8400230","type":"CDM"},{"code":"450","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":882,"maximum":924,"gross_charge":1102,"discounted_cash":1102,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":882},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":882},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":882}]}]},{"description":"N-invas Physio Std Xtrc Art Compl Bi Std","code_information":[{"code":"8400374","type":"CDM"},{"code":"450","type":"RC"},{"code":"93875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":882,"maximum":882,"gross_charge":1102,"discounted_cash":1102,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":882},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":882},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":882}]}]},{"description":"Clsd Tx Scapular Fracture W/o Manip","code_information":[{"code":"8400163","type":"CDM"},{"code":"450","type":"RC"},{"code":"23570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":881,"maximum":924,"gross_charge":1101,"discounted_cash":1101,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":881},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":881},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":881}]}]},{"description":"Stryker Lckng Scr. T10 Full Thr. 3.5mm L","code_information":[{"code":"2800507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":877,"maximum":877,"gross_charge":1096,"discounted_cash":1096,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":877}]}]},{"description":"Stryker Locking Scr. T10 Full Thr. 3.5mm","code_information":[{"code":"2800509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":877,"maximum":877,"gross_charge":1096,"discounted_cash":1096,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":877}]}]},{"description":"Clsd Tx Metacarpal Frct W/manp W/ext Fix","code_information":[{"code":"8500197","type":"CDM"},{"code":"26607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":876,"maximum":1058,"gross_charge":1095,"discounted_cash":1095,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":876},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":876},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":876}]}]},{"description":"Special Radiation Dosimetry","code_information":[{"code":"5000154","type":"CDM"},{"code":"340","type":"RC"},{"code":"77331","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":874,"maximum":874,"gross_charge":1093,"discounted_cash":1093,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":874},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":874},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":874}]}]},{"description":"Diagnostic Laryngoscopy","code_information":[{"code":"1000184","type":"CDM"},{"code":"450","type":"RC"},{"code":"31505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":872,"maximum":872,"gross_charge":1090,"discounted_cash":1090,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":872}]}]},{"description":"X Ray Hand Minimum Of 3 Views","code_information":[{"code":"8401487","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":872,"maximum":872,"gross_charge":1090,"discounted_cash":1090,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":872}]}]},{"description":"3d Rendering W/postprocess","code_information":[{"code":"5000002","type":"CDM"},{"code":"320","type":"RC"},{"code":"76377","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":871,"maximum":871,"gross_charge":1089,"discounted_cash":1089,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":871},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":871},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":871}]}]},{"description":"Acumed 14mm X 2.3 Locking Screw","code_information":[{"code":"2800028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":864,"maximum":864,"gross_charge":1080,"discounted_cash":1080,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":864}]}]},{"description":"Acumed 16mm23mm Screw","code_information":[{"code":"2800030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":864,"maximum":864,"gross_charge":1080,"discounted_cash":1080,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":864}]}]},{"description":"Acumed 2.3 X20 Locking Screw","code_information":[{"code":"2800032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":864,"maximum":864,"gross_charge":1080,"discounted_cash":1080,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":864}]}]},{"description":"Acumed 2.3x16mm Locking Screw","code_information":[{"code":"2800033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":864,"maximum":864,"gross_charge":1080,"discounted_cash":1080,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":864}]}]},{"description":"Fine Needle Aspiration With Imaging Guid","code_information":[{"code":"8400067","type":"CDM"},{"code":"450","type":"RC"},{"code":"10022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":862,"gross_charge":1078,"discounted_cash":1078,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Incision&drain Pilonidal Cyst Simple","code_information":[{"code":"8400070","type":"CDM"},{"code":"450","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":924,"gross_charge":1078,"discounted_cash":1078,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Incision&drain Pilonidal Cyst Comp","code_information":[{"code":"8400071","type":"CDM"},{"code":"450","type":"RC"},{"code":"10081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":924,"gross_charge":1078,"discounted_cash":1078,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Debride Skin At Fx Site","code_information":[{"code":"8400077","type":"CDM"},{"code":"450","type":"RC"},{"code":"11010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":1058,"gross_charge":1078,"discounted_cash":1078,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Dbrd W Rmv Fm Fx& Dslc Skn Sbq T M F Msc","code_information":[{"code":"8400078","type":"CDM"},{"code":"450","type":"RC"},{"code":"11011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":1058,"gross_charge":1078,"discounted_cash":1078,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Removal Foreign Body Foot Subcutaneous","code_information":[{"code":"8400225","type":"CDM"},{"code":"450","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":1058,"gross_charge":1078,"discounted_cash":1078,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Drainage Of Mouth Lesion","code_information":[{"code":"8400283","type":"CDM"},{"code":"450","type":"RC"},{"code":"40800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":862,"gross_charge":1078,"discounted_cash":1078,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Drain Ext Ear Abscess/hematoma Simple","code_information":[{"code":"8400342","type":"CDM"},{"code":"450","type":"RC"},{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":924,"gross_charge":1078,"discounted_cash":1078,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Windowing Cast","code_information":[{"code":"1000291","type":"CDM"},{"code":"450","type":"RC"},{"code":"29730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":861,"maximum":861,"gross_charge":1076,"discounted_cash":1076,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":861},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":861}]}]},{"description":"Micafungin (Mycamine) 100mg Vl","code_information":[{"code":"3060866","type":"CDM"},{"code":"636","type":"RC"},{"code":"46932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":860,"maximum":860,"gross_charge":1075,"discounted_cash":1075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":860}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Synth1.5 Locking Screw 9mm","code_information":[{"code":"2800553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":860,"maximum":860,"gross_charge":1075,"discounted_cash":1075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":860}]}]},{"description":"Synthes 1.5 Locking Screw 8mm","code_information":[{"code":"2800563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":860,"maximum":860,"gross_charge":1075,"discounted_cash":1075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":860}]}]},{"description":"Syntheslocking Screw 10mm","code_information":[{"code":"2800655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":860,"maximum":860,"gross_charge":1075,"discounted_cash":1075,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":860}]}]},{"description":"Us Ob < 14 Wks Addl Fetus","code_information":[{"code":"5100048","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":857,"maximum":857,"gross_charge":1071,"discounted_cash":1071,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":857},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":857},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":857}]}]},{"description":"Us Prg Utrs Rt W/img Dc Ftl&mtrl Evl Fir","code_information":[{"code":"8401383","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857,"maximum":857,"gross_charge":1071,"discounted_cash":1071,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":857},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":857},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":857}]}]},{"description":"Emer Dept Moderate Severity","code_information":[{"code":"8500422","type":"CDM"},{"code":"99283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":851,"maximum":851,"gross_charge":1064,"discounted_cash":1064,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":851}]}]},{"description":"Us Prg Utrs Rt W/img Dc Ftl&mtnl Evl Aft","code_information":[{"code":"8401385","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":850,"maximum":850,"gross_charge":1062,"discounted_cash":1062,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":850},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":850},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":850}]}]},{"description":"Xr Abd Comp Acute Inc Sup Erect &/Or Dec","code_information":[{"code":"8401518","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":846,"maximum":846,"gross_charge":1058,"discounted_cash":1058,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":846}]}]},{"description":"Acumed  10x9mm Lag Screw","code_information":[{"code":"2800759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":844,"maximum":844,"gross_charge":1055,"discounted_cash":1055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":844}]}]},{"description":"Acumed  11.5x6 Locking Screw","code_information":[{"code":"2800760","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":844,"maximum":844,"gross_charge":1055,"discounted_cash":1055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":844}]}]},{"description":"Acumed  11.5x8 Locking Screw","code_information":[{"code":"28007561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":844,"maximum":844,"gross_charge":1055,"discounted_cash":1055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":844}]}]},{"description":"Acumed  11.5x11 Locking Screw","code_information":[{"code":"28007562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":844,"maximum":844,"gross_charge":1055,"discounted_cash":1055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":844}]}]},{"description":"Acumed  11.5x12 Locking Screw","code_information":[{"code":"28007563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":844,"maximum":844,"gross_charge":1055,"discounted_cash":1055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":844}]}]},{"description":"Acumed  1.5x10 Lag Screw","code_information":[{"code":"28007565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":844,"maximum":844,"gross_charge":1055,"discounted_cash":1055,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":844}]}]},{"description":"Arthrex Suture Anchor, Corkscrew","code_information":[{"code":"2800095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":840,"maximum":840,"gross_charge":1050,"discounted_cash":1050,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":840}]}]},{"description":"H100 Dbm Crush Mix Allograft","code_information":[{"code":"2800227","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":840,"maximum":840,"gross_charge":1050,"discounted_cash":1050,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":840}]}]},{"description":"Xr Facial Bones Complete Min 3 Vw","code_information":[{"code":"8401430","type":"CDM"},{"code":"359","type":"RC"},{"code":"70150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":840,"maximum":840,"gross_charge":1050,"discounted_cash":1050,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":840}]}]},{"description":"Unlisted Procedure Breast","code_information":[{"code":"8500137","type":"CDM"},{"code":"19499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":838,"maximum":924,"gross_charge":1048,"discounted_cash":1048,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":838}]}]},{"description":"Incision Of Thrombosed Hemorrhoid Extrnl","code_information":[{"code":"8400298","type":"CDM"},{"code":"450","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":836,"maximum":924,"gross_charge":1045,"discounted_cash":1045,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":836},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":836},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":836}]}]},{"description":"Us Breast Unilat Rt W/img Doc Inc Axilla","code_information":[{"code":"8401376","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":835,"maximum":835,"gross_charge":1044,"discounted_cash":1044,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":835},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":835}]}]},{"description":"Dress/debrid P-thick Burn S","code_information":[{"code":"1000105","type":"CDM"},{"code":"450","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":834,"maximum":924,"gross_charge":1043,"discounted_cash":1043,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":834},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":834}]}]},{"description":"Bladder Irrigat Smpl Lavage&/or Instill","code_information":[{"code":"1000009","type":"CDM"},{"code":"450","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":832,"maximum":924,"gross_charge":1040,"discounted_cash":1040,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":832},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":832},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":832}]}]},{"description":"Inj Kinevac","code_information":[{"code":"3060821","type":"CDM"},{"code":"636","type":"RC"},{"code":"27005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":831,"maximum":1232,"gross_charge":1039,"discounted_cash":1039,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":831}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inj Sinus Tract Diagnostic Sinogram","code_information":[{"code":"1000167","type":"CDM"},{"code":"450","type":"RC"},{"code":"20501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":831,"maximum":924,"gross_charge":1039,"discounted_cash":1039,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":831}]}]},{"description":"Injection Of Sinus Tract Diagnostic","code_information":[{"code":"8400140","type":"CDM"},{"code":"450","type":"RC"},{"code":"20501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":831,"maximum":924,"gross_charge":1039,"discounted_cash":1039,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":831}]}]},{"description":"Njx Sclrsnt Mlt Incmptnt Vn","code_information":[{"code":"2201442","type":"CDM"},{"code":"360","type":"RC"},{"code":"36471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":830,"maximum":924,"gross_charge":1037,"discounted_cash":1037,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":830},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":830},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":830}]}]},{"description":"Vasopressin 20units/ml 1ml Vial","code_information":[{"code":"3000310","type":"CDM"},{"code":"636","type":"RC"},{"code":"42023016410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":827,"maximum":827,"gross_charge":1034,"discounted_cash":1034,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":827}]}],"drug_information":{"unit":20,"type":"UN"}},{"description":"Us Lmd Bl N-inv Phy Std Up/lw Ext Art Dp","code_information":[{"code":"5100077","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":1033,"discounted_cash":1033,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Lmd Bl N-inv Phy Std Up/lw Ext Art Dp","code_information":[{"code":"8401402","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":1033,"discounted_cash":1033,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"X Ray Spine Thoracic 3 Views","code_information":[{"code":"8401459","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":821,"maximum":821,"gross_charge":1026,"discounted_cash":1026,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":821},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":821},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":821}]}]},{"description":"Clsd Tx Tibial Shaft Fract W/manip Wi","code_information":[{"code":"8500215","type":"CDM"},{"code":"27752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":820,"maximum":924,"gross_charge":1025,"discounted_cash":1025,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":820},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":820},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":820}]}]},{"description":"Rep Cmp F/c/c/m/n/ax/g/h/f 1.1 Cm-2.5 Cm","code_information":[{"code":"8400125","type":"CDM"},{"code":"450","type":"RC"},{"code":"13131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":819,"maximum":1058,"gross_charge":1024,"discounted_cash":1024,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":819},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":819},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":819}]}]},{"description":"Clsd Tx Fract Wt Bear Artclr Prt Dst Tib","code_information":[{"code":"8500223","type":"CDM"},{"code":"27825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":818,"maximum":1058,"gross_charge":1023,"discounted_cash":1023,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":818}]}]},{"description":"Inf Agent Antigen Detection Rotavirus","code_information":[{"code":"4000205","type":"CDM"},{"code":"300","type":"RC"},{"code":"87425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":818,"maximum":818,"gross_charge":1023,"discounted_cash":1023,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":818}]}]},{"description":"Inf Agent Herpes Simpex","code_information":[{"code":"4000233","type":"CDM"},{"code":"300","type":"RC"},{"code":"87528","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":818,"maximum":818,"gross_charge":1023,"discounted_cash":1023,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":818}]}]},{"description":"Amnion Bio Or Axobiomembrane, Per Square","code_information":[{"code":"2810541","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":812,"maximum":812,"gross_charge":1015,"discounted_cash":1015,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":812},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":812},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":812}]}]},{"description":"Drain/inj Joint/bursa W/us","code_information":[{"code":"1000126","type":"CDM"},{"code":"450","type":"RC"},{"code":"20606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":811,"maximum":924,"gross_charge":1014,"discounted_cash":1014,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":811}]}]},{"description":"Arthrocentesis Aspir&/inj Inter Jt/bursa","code_information":[{"code":"8400148","type":"CDM"},{"code":"450","type":"RC"},{"code":"20606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":811,"maximum":924,"gross_charge":1014,"discounted_cash":1014,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":811}]}]},{"description":"Spinal Tap Fluid","code_information":[{"code":"8400318","type":"CDM"},{"code":"450","type":"RC"},{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":811,"maximum":924,"gross_charge":1014,"discounted_cash":1014,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":811}]}]},{"description":"Spinal Punct Therapuetic","code_information":[{"code":"8400319","type":"CDM"},{"code":"450","type":"RC"},{"code":"62272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":811,"maximum":924,"gross_charge":1014,"discounted_cash":1014,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":811}]}]},{"description":"Exparel 13.3mg/ml 10ml","code_information":[{"code":"3100000","type":"CDM"},{"code":"636","type":"RC"},{"code":"65250013309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":811,"maximum":811,"gross_charge":1014,"discounted_cash":1014,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":811}]}],"drug_information":{"unit":133,"type":"ME"}},{"description":"Electroencephalogram Eeg Monitor >1hr","code_information":[{"code":"2200860","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":811,"maximum":2300,"gross_charge":1014,"discounted_cash":1014,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Cholangiography &/Or Pancreatography","code_information":[{"code":"5000037","type":"CDM"},{"code":"329","type":"RC"},{"code":"74301","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":808,"maximum":808,"gross_charge":1010,"discounted_cash":1010,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":808}]}]},{"description":"Xr Foot Complete Rt","code_information":[{"code":"5000234","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":807,"maximum":807,"gross_charge":1009,"discounted_cash":1009,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":807}]}]},{"description":"Xr Foot Complete Lt","code_information":[{"code":"5000262","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":807,"maximum":807,"gross_charge":1009,"discounted_cash":1009,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":807}]}]},{"description":"Xr Foot Complete","code_information":[{"code":"5000289","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":807,"maximum":807,"gross_charge":1009,"discounted_cash":1009,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":807}]}]},{"description":"X Ray Foot Complete Minimum Of 3 Views","code_information":[{"code":"8401509","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":807,"maximum":807,"gross_charge":1009,"discounted_cash":1009,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":807}]}]},{"description":"Ct Guid For Placement Rad Therapy Fields","code_information":[{"code":"5200002","type":"CDM"},{"code":"352","type":"RC"},{"code":"77014","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":806,"maximum":806,"gross_charge":1007,"discounted_cash":1007,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":806},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":806},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":806}]}]},{"description":"Stryker Locking Screw T10 3.5x16mm","code_information":[{"code":"2800522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":804,"maximum":804,"gross_charge":1005,"discounted_cash":1005,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":804},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":804},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":804}]}]},{"description":"Stryker Locking Screw T10 3.5x20mm","code_information":[{"code":"2800523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":804,"maximum":804,"gross_charge":1005,"discounted_cash":1005,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":804},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":804},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":804}]}]},{"description":"X Ray Skull Complete Minimum Of 4 Views","code_information":[{"code":"8401436","type":"CDM"},{"code":"359","type":"RC"},{"code":"70260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":801,"maximum":801,"gross_charge":1001,"discounted_cash":1001,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":801},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":801},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":801}]}]},{"description":"Evolution Hgenn Putty 1cc","code_information":[{"code":"2800206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":800,"maximum":800,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":800}]}]},{"description":"Life Spine Kwire","code_information":[{"code":"2800267","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":800,"maximum":800,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":800}]}]},{"description":"Zavation 4.0 X 14mm Sd Screws","code_information":[{"code":"2800718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":800,"maximum":800,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":800}]}]},{"description":"Arthrex Canulated Screw 34mm","code_information":[{"code":"2800746","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":800,"maximum":800,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":800}]}]},{"description":"Parametrics 40m Rod","code_information":[{"code":"2800783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":800,"maximum":800,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":800}]}]},{"description":"Parametrics 45m Rod","code_information":[{"code":"2800784","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":800,"maximum":800,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":800}]}]},{"description":"Agen 4.0 X14mm Vsd","code_information":[{"code":"28007279","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":800,"maximum":800,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":800}]}]},{"description":"Repair Inter N/h/f/xtrnl Gent 2.6-7.5 Cm","code_information":[{"code":"8400112","type":"CDM"},{"code":"450","type":"RC"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":799,"maximum":924,"gross_charge":999,"discounted_cash":999,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":799},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":799},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":799}]}]},{"description":"I&d Deep Absc/hematoma Sft Tiss Nck/thrx","code_information":[{"code":"8500158","type":"CDM"},{"code":"21501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":798,"maximum":1058,"gross_charge":997,"discounted_cash":997,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":798}]}]},{"description":"Treatment Of Thigh Fracture","code_information":[{"code":"8500209","type":"CDM"},{"code":"27500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":924,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Cortex 1.3 Mm Screw 10mm","code_information":[{"code":"2800144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":796,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Cortex 1.3mm Screw 11mm","code_information":[{"code":"2800145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":796,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Cortex 1.3mm Screw 9mm","code_information":[{"code":"2800146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":796,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Xr Abd 1 View","code_information":[{"code":"5000215","type":"CDM"},{"code":"329","type":"RC"},{"code":"74018","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":796,"maximum":796,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Incision&drain Abscess Simple Single","code_information":[{"code":"8400068","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":924,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Simple Repair F E E N L M 2.5cm Or Less","code_information":[{"code":"8400100","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":796,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Simple Repair F/e/e/n/l/m 2.6cm-5.0cm","code_information":[{"code":"8400101","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":796,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Xr Abdomen Single Anteroposterior Vw","code_information":[{"code":"8401512","type":"CDM"},{"code":"329","type":"RC"},{"code":"74000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":796,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"X-ray Exam Abdomen 1 View","code_information":[{"code":"8401514","type":"CDM"},{"code":"329","type":"RC"},{"code":"74018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":796,"gross_charge":995,"discounted_cash":995,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Insert Picc Cath","code_information":[{"code":"8500277","type":"CDM"},{"code":"36569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":924,"gross_charge":989,"discounted_cash":989,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Closed Tx Nasal Fracture W/o Manip","code_information":[{"code":"8400152","type":"CDM"},{"code":"450","type":"RC"},{"code":"21310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":786,"maximum":786,"gross_charge":983,"discounted_cash":983,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":786}]}]},{"description":"Open Tx Nose Fx Uncomplicatd","code_information":[{"code":"8500154","type":"CDM"},{"code":"21325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":786,"maximum":1508,"gross_charge":983,"discounted_cash":983,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":786}]}]},{"description":"Ultrasound Spinal Canal And Contents","code_information":[{"code":"8401381","type":"CDM"},{"code":"402","type":"RC"},{"code":"76800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":786,"maximum":786,"gross_charge":982,"discounted_cash":982,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":786}]}]},{"description":"Rmvl Devital Tis 20cm/<","code_information":[{"code":"2202354","type":"CDM"},{"code":"360","type":"RC"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":924,"gross_charge":980,"discounted_cash":980,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Treat Dental Ridge Fracture","code_information":[{"code":"8500155","type":"CDM"},{"code":"21440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":784,"maximum":1232,"gross_charge":980,"discounted_cash":980,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":784}]}]},{"description":"Stryker 5x150 Apex S/d Half Pin 50thr","code_information":[{"code":"2800445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":783,"maximum":783,"gross_charge":979,"discounted_cash":979,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":783}]}]},{"description":"Us Duplex Arterial/venous Flow","code_information":[{"code":"5100005","type":"CDM"},{"code":"402","type":"RC"},{"code":"93975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":979,"discounted_cash":979,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Dp Sc Art Infl&ven Outfl Ab/plv/scr","code_information":[{"code":"8401409","type":"CDM"},{"code":"921","type":"RC"},{"code":"93975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":979,"discounted_cash":979,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Dp Sc Art Infl&ven Outfl Ab/plv/scr","code_information":[{"code":"8401410","type":"CDM"},{"code":"921","type":"RC"},{"code":"93976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":979,"discounted_cash":979,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Us Dp Sc Art In&ven Out Penile Vess Cmp","code_information":[{"code":"8401411","type":"CDM"},{"code":"921","type":"RC"},{"code":"93980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":979,"discounted_cash":979,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Duplex Scan Of Arterial Inflow And Venou","code_information":[{"code":"9401411","type":"CDM"},{"code":"921","type":"RC"},{"code":"93985","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":979,"discounted_cash":979,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Metro Headed Screw 20mm","code_information":[{"code":"2800763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":782,"maximum":782,"gross_charge":978,"discounted_cash":978,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":782}]}]},{"description":"Tube Thoracostomy Inc Conn To Drain Sys","code_information":[{"code":"8500268","type":"CDM"},{"code":"32551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":781,"maximum":1058,"gross_charge":976,"discounted_cash":976,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":781},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":781},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":781}]}]},{"description":"Stryker Locking Screw T10 3.5 X 14mm","code_information":[{"code":"2800520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":780,"maximum":780,"gross_charge":975,"discounted_cash":975,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":780},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":780},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":780}]}]},{"description":"Clsd Tx Knee Dislocation Wo Anes","code_information":[{"code":"8500212","type":"CDM"},{"code":"27550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":778,"maximum":924,"gross_charge":973,"discounted_cash":973,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":778}]}]},{"description":"Medartis 1.5mm X 10mm Cortex Bone Screw","code_information":[{"code":"2802716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":778,"maximum":778,"gross_charge":973,"discounted_cash":973,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":778}]}]},{"description":"Xr Mandible Complete Minimum Of 4 Vw","code_information":[{"code":"8401427","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":774,"maximum":774,"gross_charge":967,"discounted_cash":967,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":774}]}]},{"description":"Clsd Tx Radial/ulnar Shaft Fract W/man","code_information":[{"code":"8500180","type":"CDM"},{"code":"25565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":772,"maximum":1058,"gross_charge":965,"discounted_cash":965,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":772},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":772},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":772}]}]},{"description":"Ob Us Detailed Sngl Fetus","code_information":[{"code":"8401386","type":"CDM"},{"code":"402","type":"RC"},{"code":"76811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":771,"maximum":771,"gross_charge":964,"discounted_cash":964,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":771},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":771},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":771}]}]},{"description":"Clsd Tx Radial Head/neck Fract W/manip","code_information":[{"code":"8500174","type":"CDM"},{"code":"24655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":771,"maximum":924,"gross_charge":964,"discounted_cash":964,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":771},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":771},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":771}]}]},{"description":"Smpl Rpr S/n/s/g/t 20.1cm To 30.0cm","code_information":[{"code":"8400099","type":"CDM"},{"code":"450","type":"RC"},{"code":"12006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":770,"maximum":1058,"gross_charge":963,"discounted_cash":963,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":770}]}]},{"description":"Cardioversion Elective Arrhyt Xtrnl","code_information":[{"code":"8400359","type":"CDM"},{"code":"450","type":"RC"},{"code":"92960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":770,"gross_charge":963,"discounted_cash":963,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Rpr Lip Full Thkns Vermilion Only","code_information":[{"code":"8500282","type":"CDM"},{"code":"40650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":769,"maximum":1232,"gross_charge":961,"discounted_cash":961,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":769},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":769},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":769}]}]},{"description":"Screw 10*20mm","code_information":[{"code":"2811526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":767,"maximum":767,"gross_charge":959,"discounted_cash":959,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":767},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":767},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":767}]}]},{"description":"Hospital Observation Per Hr","code_information":[{"code":"8400433","type":"CDM"},{"code":"450","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":766,"maximum":2800,"gross_charge":957,"discounted_cash":957,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2800}]}]},{"description":"Stryker 1.7mm T-plate","code_information":[{"code":"2800426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":766,"maximum":766,"gross_charge":957,"discounted_cash":957,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":766}]}]},{"description":"Simple Repair F/e/e/n/l/m 5.1cm-7.5cm","code_information":[{"code":"8400102","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":766,"maximum":924,"gross_charge":957,"discounted_cash":957,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":766}]}]},{"description":"Insert Pleural Cath","code_information":[{"code":"8500267","type":"CDM"},{"code":"32550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":765,"maximum":1058,"gross_charge":956,"discounted_cash":956,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":765},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":765},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":765}]}]},{"description":"Mimedx Epifix 2.0 X3.0 Cm Per Cm","code_information":[{"code":"2800311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":762,"maximum":762,"gross_charge":953,"discounted_cash":953,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":762},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":762},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":762}]}]},{"description":"Inj Tc-99m Sulfur Colloid","code_information":[{"code":"3060824","type":"CDM"},{"code":"636","type":"RC"},{"code":"50419022005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":761,"maximum":761,"gross_charge":951,"discounted_cash":951,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":761},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":761},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":761}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inj- Tc-99m Sulfur Colloid","code_information":[{"code":"3060825","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":761,"maximum":761,"gross_charge":951,"discounted_cash":951,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":761},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":761},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":761}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mimed Epifix 4.0 X4.0 Cm (Charged Per Sq","code_information":[{"code":"2800308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":760,"maximum":760,"gross_charge":950,"discounted_cash":950,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":760}]}]},{"description":"Duplex Scan Of Arterial Inflow And Venou","code_information":[{"code":"9411411","type":"CDM"},{"code":"921","type":"RC"},{"code":"93986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":948,"discounted_cash":948,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":758},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":758},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":758},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"X Ray Hand 2 Views","code_information":[{"code":"8401486","type":"CDM"},{"code":"359","type":"RC"},{"code":"73120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":757,"maximum":757,"gross_charge":946,"discounted_cash":946,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":757}]}]},{"description":"Depuy Pinnacle Cancellous Bone Screw 6.5","code_information":[{"code":"2800171","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":757,"maximum":757,"gross_charge":946,"discounted_cash":946,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":757}]}]},{"description":"Iv Infusion Initial","code_information":[{"code":"3100005","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":757,"gross_charge":946,"discounted_cash":946,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Clsd Tx Radial Shaft Fracture W/manip","code_information":[{"code":"8500177","type":"CDM"},{"code":"25505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":756,"maximum":924,"gross_charge":945,"discounted_cash":945,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":756}]}]},{"description":"Xr Toe(s) Complete Rt","code_information":[{"code":"5000248","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":755,"maximum":755,"gross_charge":944,"discounted_cash":944,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":755}]}]},{"description":"Xr Toe(s) Complete Lt","code_information":[{"code":"5000273","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":755,"maximum":755,"gross_charge":944,"discounted_cash":944,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":755}]}]},{"description":"Xr Toe(s) Complete","code_information":[{"code":"5000321","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":755,"maximum":755,"gross_charge":944,"discounted_cash":944,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":755}]}]},{"description":"X Ray Toe(s) Minimum Of 2 Views","code_information":[{"code":"8401511","type":"CDM"},{"code":"359","type":"RC"},{"code":"73660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":755,"maximum":755,"gross_charge":944,"discounted_cash":944,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":755}]}]},{"description":"Ti Non Lock Screw 2.4 X 14mm","code_information":[{"code":"2800663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":755,"maximum":755,"gross_charge":944,"discounted_cash":944,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":755}]}]},{"description":"Ti Non Lock Screw 2.4 X 16mm","code_information":[{"code":"2800664","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":755,"maximum":755,"gross_charge":944,"discounted_cash":944,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":755}]}]},{"description":"Strapping Shoulder Eg Velpeau","code_information":[{"code":"1000271","type":"CDM"},{"code":"450","type":"RC"},{"code":"29240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":754,"maximum":754,"gross_charge":943,"discounted_cash":943,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":754},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":754},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":754}]}]},{"description":"Us Pelvic (Nonob) Rt W/img Doc Lmt/f-up","code_information":[{"code":"8401394","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":754,"maximum":754,"gross_charge":943,"discounted_cash":943,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":754},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":754},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":754}]}]},{"description":"Pos Airway Pressure Cpap","code_information":[{"code":"2200590","type":"CDM"},{"code":"360","type":"RC"},{"code":"94660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":751,"maximum":751,"gross_charge":939,"discounted_cash":939,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":751}]}]},{"description":"Xr Sinuses Paranasal Comp Min 3 Vw","code_information":[{"code":"8401434","type":"CDM"},{"code":"359","type":"RC"},{"code":"70220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748,"maximum":748,"gross_charge":935,"discounted_cash":935,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":748},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":748},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":748}]}]},{"description":"Clsd Tx Ulnar Shaft Fracture W/manip","code_information":[{"code":"8500178","type":"CDM"},{"code":"25535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":746,"maximum":924,"gross_charge":933,"discounted_cash":933,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":746},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":746},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":746}]}]},{"description":"X Ray Calcaneus Minimum Of 2 Views","code_information":[{"code":"8401510","type":"CDM"},{"code":"359","type":"RC"},{"code":"73650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":744,"maximum":744,"gross_charge":930,"discounted_cash":930,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":744}]}]},{"description":"Repair Inter F/e/e/n/l/m&/muc 2.6-5.0 Cm","code_information":[{"code":"8400116","type":"CDM"},{"code":"450","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":743,"maximum":924,"gross_charge":929,"discounted_cash":929,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":743},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":743},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":743}]}]},{"description":"App Short Leg Splint Calf-foot","code_information":[{"code":"1000119","type":"CDM"},{"code":"450","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":742,"gross_charge":928,"discounted_cash":928,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"X Ray Pelvis Complete Minimum Of 3 Views","code_information":[{"code":"8401467","type":"CDM"},{"code":"359","type":"RC"},{"code":"72190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":742,"maximum":742,"gross_charge":928,"discounted_cash":928,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":742}]}]},{"description":"Stryker 3.0 Mm Asnis Micro Cannulated Sc","code_information":[{"code":"2800434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":741,"maximum":741,"gross_charge":926,"discounted_cash":926,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":741}]}]},{"description":"Stryker 3.0mm Asnis Micro Canulated Scre","code_information":[{"code":"2800436","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":741,"maximum":741,"gross_charge":926,"discounted_cash":926,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":741}]}]},{"description":"Us Preg Uterus Rt W/img Doc Transvaginal","code_information":[{"code":"8401391","type":"CDM"},{"code":"340","type":"RC"},{"code":"76817","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":738,"maximum":738,"gross_charge":923,"discounted_cash":923,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":738},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":738},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":738}]}]},{"description":"Stryker 2.0 Mm Asnis Micro Cannulated Sc","code_information":[{"code":"2800427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":735,"maximum":735,"gross_charge":919,"discounted_cash":919,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":735}]}]},{"description":"Stryker 2.0mm Cannulated Screw 16/7mm","code_information":[{"code":"2800429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":735,"maximum":735,"gross_charge":919,"discounted_cash":919,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":735}]}]},{"description":"Stryker Screw 2.0mm Asnis Micro Cannulat","code_information":[{"code":"2800544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":735,"maximum":735,"gross_charge":919,"discounted_cash":919,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":735}]}]},{"description":"Clsd Tx Distal Radioulnar Disloc W/manip","code_information":[{"code":"8500187","type":"CDM"},{"code":"25675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":734,"maximum":924,"gross_charge":918,"discounted_cash":918,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":734},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":734},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":734}]}]},{"description":"Xr Spine Lumbosacral Bend 2-3 Vw","code_information":[{"code":"8401465","type":"CDM"},{"code":"359","type":"RC"},{"code":"72120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":734,"maximum":734,"gross_charge":918,"discounted_cash":918,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":734},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":734},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":734}]}]},{"description":"Xr Shoulder Complete Minimum Of 2 Vw","code_information":[{"code":"8401475","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":732,"maximum":732,"gross_charge":915,"discounted_cash":915,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":732},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":732},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":732}]}]},{"description":"Clsd Tx Calcaneal Fract Wo Manip","code_information":[{"code":"8400228","type":"CDM"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Clsd Tx Talus Fract Wo Manip","code_information":[{"code":"8400229","type":"CDM"},{"code":"450","type":"RC"},{"code":"28430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Clsd Tx Fract Grt Toe Phlnx/phlng Wo/mnp","code_information":[{"code":"8400231","type":"CDM"},{"code":"450","type":"RC"},{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Clsd Tx Fract Grt Toe Phlnx/phlng W/mnp","code_information":[{"code":"8400232","type":"CDM"},{"code":"450","type":"RC"},{"code":"28495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Clsd Tx Fract Phlnx/phlng Wo/m","code_information":[{"code":"8400233","type":"CDM"},{"code":"450","type":"RC"},{"code":"28510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Clsd Tx Fract Phlnx/phlng W/m","code_information":[{"code":"8400234","type":"CDM"},{"code":"450","type":"RC"},{"code":"28515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Clsd Tx Mcp Joint Dislocation Wo Anes","code_information":[{"code":"8400235","type":"CDM"},{"code":"450","type":"RC"},{"code":"28630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Clsd Tx Ip Joint Disloc Wo/anes","code_information":[{"code":"8400236","type":"CDM"},{"code":"450","type":"RC"},{"code":"28660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Clsd Tx Supra/transcondylar Humeral Frct","code_information":[{"code":"8500169","type":"CDM"},{"code":"24530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":924,"gross_charge":912,"discounted_cash":912,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730}]}]},{"description":"Stryker 3.0 Mm Cannulated Screw 17/4mm","code_information":[{"code":"2800435","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":729,"maximum":729,"gross_charge":911,"discounted_cash":911,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":729},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":729}]}]},{"description":"Debride Ext Eczemat/inf Skin>10% Body","code_information":[{"code":"1000086","type":"CDM"},{"code":"450","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":924,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Debride Exten Eczematous/infected Skin","code_information":[{"code":"8400076","type":"CDM"},{"code":"450","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":924,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Tx Superficial Wnd Dehiscence Smpl Closr","code_information":[{"code":"8400105","type":"CDM"},{"code":"450","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":924,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Repair Inter N/h/f/xtrnl Gent 7.6-12.5cm","code_information":[{"code":"8400113","type":"CDM"},{"code":"450","type":"RC"},{"code":"12044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":1058,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Intmd Rpr N-hf/genit12.6-20","code_information":[{"code":"8400114","type":"CDM"},{"code":"450","type":"RC"},{"code":"12045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":1058,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Repair Complex Trunk 1.1 Cm To 2.5 Cm","code_information":[{"code":"8400119","type":"CDM"},{"code":"450","type":"RC"},{"code":"13100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":1058,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Repair Complex Trunk 2.6 Cm To 7.5 Cm","code_information":[{"code":"8400120","type":"CDM"},{"code":"450","type":"RC"},{"code":"13101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":1232,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Repair Complex S/a/l 1.1 Cm To 2.5 Cm","code_information":[{"code":"8400122","type":"CDM"},{"code":"450","type":"RC"},{"code":"13120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":1058,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Rep Cmp F/c/c/m/n/ax/g/h/f 2.6 Cm-7.5 Cm","code_information":[{"code":"8400126","type":"CDM"},{"code":"450","type":"RC"},{"code":"13132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":1232,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Rep Cmp F/c/c/m/n/ax/g/h/f Ea 5 Cm/<","code_information":[{"code":"8400127","type":"CDM"},{"code":"450","type":"RC"},{"code":"13133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":924,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Rep Cmp Eyelid/nose/ear/lip 1.1-2.5 Cm","code_information":[{"code":"8400128","type":"CDM"},{"code":"450","type":"RC"},{"code":"13151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":725,"maximum":1232,"gross_charge":906,"discounted_cash":906,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"App Cast Elbow-finger Short Arm","code_information":[{"code":"1000121","type":"CDM"},{"code":"450","type":"RC"},{"code":"29075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":723,"maximum":723,"gross_charge":904,"discounted_cash":904,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":723},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":723},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":723}]}]},{"description":"Emer Dept Low To Moderate Severity","code_information":[{"code":"8400421","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":722,"maximum":722,"gross_charge":903,"discounted_cash":903,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":722}]}]},{"description":"Us Chest Rt W/img Doc","code_information":[{"code":"8401374","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":722,"maximum":722,"gross_charge":902,"discounted_cash":902,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":722}]}]},{"description":"Excision Pilonidal Cyst Sinus Extensive","code_information":[{"code":"8500094","type":"CDM"},{"code":"11771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":721,"maximum":1232,"gross_charge":901,"discounted_cash":901,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":721},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":721},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":721}]}]},{"description":"Cook Ureteral Stent 6 X 26","code_information":[{"code":"2800108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":720,"maximum":720,"gross_charge":900,"discounted_cash":900,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":720}]}]},{"description":"Stryker Non-locking Screw 3.0x16mm","code_information":[{"code":"2800538","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":720,"maximum":720,"gross_charge":900,"discounted_cash":900,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":720}]}]},{"description":"Stress Tte Complete","code_information":[{"code":"4200003","type":"CDM"},{"code":"730","type":"RC"},{"code":"93351","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Echo Transesophageal","code_information":[{"code":"4200004","type":"CDM"},{"code":"730","type":"RC"},{"code":"93314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Echo Transesophageal","code_information":[{"code":"4200005","type":"CDM"},{"code":"730","type":"RC"},{"code":"93313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Tte F-up Or Lmtd","code_information":[{"code":"4200006","type":"CDM"},{"code":"730","type":"RC"},{"code":"93308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Echo Transthoracic","code_information":[{"code":"4200019","type":"CDM"},{"code":"730","type":"RC"},{"code":"93303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Tte For Congenital Cardiac Anomalies Cmp","code_information":[{"code":"8400367","type":"CDM"},{"code":"450","type":"RC"},{"code":"93303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Tte Rt W/image Doc 2d Inc M-mode Record","code_information":[{"code":"8400368","type":"CDM"},{"code":"450","type":"RC"},{"code":"93308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Tee R-t Img 2d W/probe Plmt Only","code_information":[{"code":"8400369","type":"CDM"},{"code":"450","type":"RC"},{"code":"93313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Tee R-t Img 2d Img Acquisj I&r Only","code_information":[{"code":"8400370","type":"CDM"},{"code":"450","type":"RC"},{"code":"93314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Echo Tthrc R-t2d-+m-mde Rst&strs Cnt Ecg","code_information":[{"code":"8400371","type":"CDM"},{"code":"450","type":"RC"},{"code":"93351","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":719,"gross_charge":899,"discounted_cash":899,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Clsd Tx Trimalleolar Ankle Fract W/manip","code_information":[{"code":"8500221","type":"CDM"},{"code":"27818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":717,"maximum":924,"gross_charge":896,"discounted_cash":896,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":717},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":717},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":717}]}]},{"description":"Office Or Other Outpatient Visit For The","code_information":[{"code":"6100063","type":"CDM"},{"code":"424","type":"RC"},{"code":"99202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":716,"gross_charge":895,"discounted_cash":895,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Office Or Other Outpatient Visit For The","code_information":[{"code":"6100064","type":"CDM"},{"code":"424","type":"RC"},{"code":"99202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":716,"gross_charge":895,"discounted_cash":895,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"6100067","type":"CDM"},{"code":"521","type":"RC"},{"code":"99203","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":716,"maximum":716,"gross_charge":895,"discounted_cash":895,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":716}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"6100068","type":"CDM"},{"code":"521","type":"RC"},{"code":"99203","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":716,"maximum":716,"gross_charge":895,"discounted_cash":895,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":716}]}]},{"description":"Insert Temp Bladder Cath","code_information":[{"code":"1000179","type":"CDM"},{"code":"450","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":716,"maximum":924,"gross_charge":895,"discounted_cash":895,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":716}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"1000203","type":"CDM"},{"code":"450","type":"RC"},{"code":"65210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":715,"maximum":715,"gross_charge":894,"discounted_cash":894,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":715}]}]},{"description":"Ins Non-tun Ctr Cvc Age 5 Yr/>","code_information":[{"code":"8500276","type":"CDM"},{"code":"36556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":709,"maximum":924,"gross_charge":886,"discounted_cash":886,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":709}]}]},{"description":"Closed Tx Tmj Dislocation Init/subseq","code_information":[{"code":"8400157","type":"CDM"},{"code":"450","type":"RC"},{"code":"21480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":708,"maximum":924,"gross_charge":885,"discounted_cash":885,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":708}]}]},{"description":"Repair Tongue Laceration 2.6cm Or Comp","code_information":[{"code":"8400287","type":"CDM"},{"code":"450","type":"RC"},{"code":"41252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":708,"maximum":1058,"gross_charge":885,"discounted_cash":885,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":708}]}]},{"description":"X Ray Spine Thoracic 2 Views","code_information":[{"code":"8401458","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":707,"maximum":707,"gross_charge":884,"discounted_cash":884,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":707},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":707},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":707}]}]},{"description":"Xr Abd 3+ Views","code_information":[{"code":"5000217","type":"CDM"},{"code":"320","type":"RC"},{"code":"74021","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":706,"maximum":706,"gross_charge":882,"discounted_cash":882,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":706}]}]},{"description":"X-ray Exam Abdomen 3+ Views","code_information":[{"code":"8401517","type":"CDM"},{"code":"320","type":"RC"},{"code":"74021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":706,"maximum":706,"gross_charge":882,"discounted_cash":882,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":706}]}]},{"description":"X Ray Femur Minimum 2 Views","code_information":[{"code":"8401498","type":"CDM"},{"code":"329","type":"RC"},{"code":"73552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":705,"maximum":705,"gross_charge":881,"discounted_cash":881,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":705},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":705},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":705}]}]},{"description":"Level Iv Pathology Gross And Micro Exam","code_information":[{"code":"4000288","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":703,"maximum":703,"gross_charge":879,"discounted_cash":879,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":703},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":703},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":703}]}]},{"description":"Wedge Excision Skin Nail Fold","code_information":[{"code":"8400093","type":"CDM"},{"code":"450","type":"RC"},{"code":"11765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":924,"gross_charge":878,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Tx Superficial Wnd Dehisc Smpl Clsr W/pk","code_information":[{"code":"8400106","type":"CDM"},{"code":"450","type":"RC"},{"code":"12021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":924,"gross_charge":878,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Repair Inter S/a/t/e 2.5 Cm Or Less","code_information":[{"code":"8400107","type":"CDM"},{"code":"450","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":924,"gross_charge":878,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Repair Inter S/a/t/e 22.6 Cm To 7.5 Cm","code_information":[{"code":"8400108","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":924,"gross_charge":878,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Repair Inter S/a/t/e 7.6-12.5 Cm","code_information":[{"code":"8400109","type":"CDM"},{"code":"450","type":"RC"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":1058,"gross_charge":878,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Repair Inter N/h/f/xtrnl Gent 2.5cm/<","code_information":[{"code":"8400111","type":"CDM"},{"code":"450","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":924,"gross_charge":878,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Dress/debrid P-thick Burn Large","code_information":[{"code":"8400135","type":"CDM"},{"code":"450","type":"RC"},{"code":"16030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":1058,"gross_charge":878,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Rep Cmp Eyelid/nose/ear/lip Ea 5 Cm /<","code_information":[{"code":"8400130","type":"CDM"},{"code":"450","type":"RC"},{"code":"13153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":1232,"gross_charge":877,"discounted_cash":877,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"X Ray Tibia And Fibula 2 Views","code_information":[{"code":"8401503","type":"CDM"},{"code":"329","type":"RC"},{"code":"73590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":702,"gross_charge":877,"discounted_cash":877,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"1000204","type":"CDM"},{"code":"450","type":"RC"},{"code":"65222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":701,"maximum":701,"gross_charge":876,"discounted_cash":876,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":701},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":701},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":701}]}]},{"description":"X Ray Knee 1 Or 2 Views","code_information":[{"code":"8401499","type":"CDM"},{"code":"329","type":"RC"},{"code":"73560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":701,"maximum":701,"gross_charge":876,"discounted_cash":876,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":701},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":701},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":701}]}]},{"description":"Clsd Tx Proximal Humeral Fract W/manip","code_information":[{"code":"8500165","type":"CDM"},{"code":"23605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":700,"maximum":1058,"gross_charge":875,"discounted_cash":875,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":700}]}]},{"description":"Tl Medical 40mm Straight Rod","code_information":[{"code":"2800674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":700,"maximum":700,"gross_charge":875,"discounted_cash":875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":700}]}]},{"description":"Synthes Lcp Plate 12 Holes","code_information":[{"code":"2800743","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":700,"maximum":700,"gross_charge":875,"discounted_cash":875,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":700}]}]},{"description":"Initial Treatment Of Burn(s)","code_information":[{"code":"1000157","type":"CDM"},{"code":"450","type":"RC"},{"code":"16000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":698,"maximum":698,"gross_charge":872,"discounted_cash":872,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":698}]}]},{"description":"Stress Test","code_information":[{"code":"42000020","type":"CDM"},{"code":"730","type":"RC"},{"code":"93015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":698,"gross_charge":872,"discounted_cash":872,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Stryker Untrheaded Guidewire 1.4mm X150m","code_information":[{"code":"2800549","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":698,"maximum":698,"gross_charge":872,"discounted_cash":872,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":698}]}]},{"description":"Quinupristin/dalfopristin","code_information":[{"code":"8400943","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":697,"maximum":697,"gross_charge":871,"discounted_cash":871,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":697},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":697},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":697}]}]},{"description":"Clsd Tx Shldr Dislocation W/manip W/ans","code_information":[{"code":"8500167","type":"CDM"},{"code":"23655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":695,"maximum":924,"gross_charge":869,"discounted_cash":869,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":695},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":695},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":695}]}]},{"description":"Wright 2.7 X 16mm Non-locking Screw","code_information":[{"code":"2800695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":694,"maximum":694,"gross_charge":868,"discounted_cash":868,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":694}]}]},{"description":"Wright 2.7 X 20mm Non Locking Screw","code_information":[{"code":"2800696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":694,"maximum":694,"gross_charge":868,"discounted_cash":868,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":694}]}]},{"description":"Wright 2.7 X 22mm Non-locking Screw","code_information":[{"code":"2800697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":694,"maximum":694,"gross_charge":868,"discounted_cash":868,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":694}]}]},{"description":"X Ray Chest Complete Minimum Of 4 Views","code_information":[{"code":"8401444","type":"CDM"},{"code":"359","type":"RC"},{"code":"71030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":694,"maximum":694,"gross_charge":867,"discounted_cash":867,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":694}]}]},{"description":"Pt Re- Eval","code_information":[{"code":"6100031","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":691,"gross_charge":864,"discounted_cash":864,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Re- Eval","code_information":[{"code":"6100032","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":691,"gross_charge":864,"discounted_cash":864,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Cathflo Activase 2mg","code_information":[{"code":"3000044","type":"CDM"},{"code":"636","type":"RC"},{"code":"59242994164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":691,"maximum":691,"gross_charge":864,"discounted_cash":864,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":691}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"I&d Ischiorct&/prirct Absc Spx","code_information":[{"code":"8500296","type":"CDM"},{"code":"46040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":691,"maximum":1232,"gross_charge":864,"discounted_cash":864,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":691}]}]},{"description":"Remove Tendon Sheath Lesion","code_information":[{"code":"8500190","type":"CDM"},{"code":"26160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":690,"maximum":1232,"gross_charge":863,"discounted_cash":863,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":690}]}]},{"description":"Smpl Rpr S/n/s/g/t 12.6 To 20.0cm","code_information":[{"code":"8400098","type":"CDM"},{"code":"450","type":"RC"},{"code":"12005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":690,"maximum":1058,"gross_charge":863,"discounted_cash":863,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":690},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":690}]}]},{"description":"Gastrointestinal Pathogen Panel","code_information":[{"code":"8400756","type":"CDM"},{"code":"300","type":"RC"},{"code":"87506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":687,"maximum":687,"gross_charge":859,"discounted_cash":859,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":687},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":687},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":687}]}]},{"description":"Preputial Stretching","code_information":[{"code":"1000139","type":"CDM"},{"code":"450","type":"RC"},{"code":"54450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":686,"maximum":924,"gross_charge":857,"discounted_cash":857,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":686},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":686},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":686}]}]},{"description":"Delta Xtend Non-lckng Metaglene Screw","code_information":[{"code":"2800160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":684,"maximum":684,"gross_charge":855,"discounted_cash":855,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":684}]}]},{"description":"Depuy 4.5x18 Non Locking Screw","code_information":[{"code":"2800165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":684,"maximum":684,"gross_charge":855,"discounted_cash":855,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":684}]}]},{"description":"Application Finger Splint Dynamic","code_information":[{"code":"1000001","type":"CDM"},{"code":"450","type":"RC"},{"code":"29131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":682,"maximum":682,"gross_charge":853,"discounted_cash":853,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":682}]}]},{"description":"Clsd Tx Ulnar Fract Proximal End W/m","code_information":[{"code":"8500176","type":"CDM"},{"code":"24675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":681,"maximum":924,"gross_charge":851,"discounted_cash":851,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":681}]}]},{"description":"Removal/revision Of Cast","code_information":[{"code":"1000219","type":"CDM"},{"code":"450","type":"RC"},{"code":"29700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":681,"maximum":681,"gross_charge":851,"discounted_cash":851,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":681}]}]},{"description":"Parametrics 50 Mm Screw","code_information":[{"code":"2800785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":680,"maximum":680,"gross_charge":850,"discounted_cash":850,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":680}]}]},{"description":"Clsd Tx Radio/intrcrpl Dslc 1/> Bone W/m","code_information":[{"code":"8500186","type":"CDM"},{"code":"25660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":680,"maximum":924,"gross_charge":850,"discounted_cash":850,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":680}]}]},{"description":"Level V Pathology Gross And Micro Exam","code_information":[{"code":"4000289","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":679,"maximum":679,"gross_charge":849,"discounted_cash":849,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":679},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":679},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":679}]}]},{"description":"Us Dp Sc Ext Vn Inc Resp Cmp&othr Mnv Ul","code_information":[{"code":"8401408","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":845,"discounted_cash":845,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Strapping Elbow Or Wrist","code_information":[{"code":"1000267","type":"CDM"},{"code":"450","type":"RC"},{"code":"29260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":674,"maximum":674,"gross_charge":843,"discounted_cash":843,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":674}]}]},{"description":"App Short Arm Splint Forearm-hand Static","code_information":[{"code":"1000116","type":"CDM"},{"code":"450","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":674,"maximum":674,"gross_charge":843,"discounted_cash":843,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":674}]}]},{"description":"Er Visit Level 2","code_information":[{"code":"1000289","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":674,"maximum":674,"gross_charge":842,"discounted_cash":842,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":674}]}]},{"description":"Xr Chest 3 Views","code_information":[{"code":"5000219","type":"CDM"},{"code":"320","type":"RC"},{"code":"71047","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":673,"maximum":673,"gross_charge":841,"discounted_cash":841,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":673}]}]},{"description":"X-ray Exam Chest 3 Views","code_information":[{"code":"8401447","type":"CDM"},{"code":"320","type":"RC"},{"code":"71047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":673,"maximum":673,"gross_charge":841,"discounted_cash":841,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":673},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":673}]}]},{"description":"X Ray Spine Lumbosacral 2 Or 3 Views","code_information":[{"code":"8401462","type":"CDM"},{"code":"359","type":"RC"},{"code":"72100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":672,"maximum":672,"gross_charge":840,"discounted_cash":840,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":672}]}]},{"description":"Xr Chest 2 Views","code_information":[{"code":"5000218","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":671,"maximum":671,"gross_charge":839,"discounted_cash":839,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":671},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":671},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":671}]}]},{"description":"X-ray Exam Chest 2 Views","code_information":[{"code":"8401446","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":671,"maximum":671,"gross_charge":839,"discounted_cash":839,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":671},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":671},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":671}]}]},{"description":"Methylene Blue 5mg/ml Ampule","code_information":[{"code":"3000191","type":"CDM"},{"code":"636","type":"RC"},{"code":"51703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":670,"maximum":924,"gross_charge":838,"discounted_cash":838,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":670}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Strapping Knee","code_information":[{"code":"1000270","type":"CDM"},{"code":"450","type":"RC"},{"code":"29530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":670,"maximum":670,"gross_charge":837,"discounted_cash":837,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":670}]}]},{"description":"Removal Foreign Body Deep Thigh/knee","code_information":[{"code":"8500208","type":"CDM"},{"code":"27372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":668,"maximum":2196,"gross_charge":835,"discounted_cash":835,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":668}]}]},{"description":"X Ray Spine Thoracic Minimum Of 4 Views","code_information":[{"code":"8401460","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":666,"maximum":666,"gross_charge":833,"discounted_cash":833,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":666}]}]},{"description":"Tilt Table Eval With Contin Ecg Monitor","code_information":[{"code":"4200011","type":"CDM"},{"code":"730","type":"RC"},{"code":"93660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":666,"gross_charge":832,"discounted_cash":832,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Eval Cvs Fct W/tlt Tbl Evl W/cnt Ecg Mtr","code_information":[{"code":"8400373","type":"CDM"},{"code":"450","type":"RC"},{"code":"93660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":666,"gross_charge":832,"discounted_cash":832,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Strapping Hand Or Finger","code_information":[{"code":"1000268","type":"CDM"},{"code":"450","type":"RC"},{"code":"29280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":666,"maximum":666,"gross_charge":832,"discounted_cash":832,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":666}]}]},{"description":"Xr Chest 4 Views","code_information":[{"code":"5000220","type":"CDM"},{"code":"320","type":"RC"},{"code":"71048","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":665,"maximum":665,"gross_charge":831,"discounted_cash":831,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":665}]}]},{"description":"X-ray Chest Complete Minimum Of 4 Views","code_information":[{"code":"8401448","type":"CDM"},{"code":"320","type":"RC"},{"code":"71048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":665,"maximum":665,"gross_charge":831,"discounted_cash":831,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":665}]}]},{"description":"Xr Rib Uni Inc Posteroant Chest M 3v","code_information":[{"code":"8401450","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":665,"maximum":665,"gross_charge":831,"discounted_cash":831,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":665}]}]},{"description":"Laryngoscopy Flexible W/emoval Of Fb","code_information":[{"code":"8500265","type":"CDM"},{"code":"31577","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":664,"maximum":1058,"gross_charge":830,"discounted_cash":830,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":664},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":664},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":664}]}]},{"description":"Synthes 3.5 Va Locking Screw 70mm","code_information":[{"code":"2800599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":660,"maximum":660,"gross_charge":825,"discounted_cash":825,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":660}]}]},{"description":"Drain/inj Joint/bursa W/o Us","code_information":[{"code":"1000003","type":"CDM"},{"code":"450","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":657,"maximum":924,"gross_charge":821,"discounted_cash":821,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":657},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":657},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":657}]}]},{"description":"Stryker Lcking Screw T10 Full Thread 3.5","code_information":[{"code":"2800506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw Full Thread 3.5mm/","code_information":[{"code":"2800518","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw Full Thread3.5mm/l","code_information":[{"code":"2800519","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw T10 3.5mm/32mm","code_information":[{"code":"2800521","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw T10 Full 3.5x20mm","code_information":[{"code":"2800524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw T10 Full 3.5x26mm","code_information":[{"code":"2800525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw T10 Full Thread 3.","code_information":[{"code":"2800526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw T10 Full Thread 3.","code_information":[{"code":"2800527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw T10 Full Thread 3.","code_information":[{"code":"2800528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Stryker Locking Screw T10 Full Thread 3.","code_information":[{"code":"2800529","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":656,"gross_charge":820,"discounted_cash":820,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Drain/inj Mjr Joint/bursa W/us","code_information":[{"code":"1000002","type":"CDM"},{"code":"450","type":"RC"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":655,"maximum":924,"gross_charge":819,"discounted_cash":819,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":655}]}]},{"description":"Acute Hepatitis Panel","code_information":[{"code":"4000003","type":"CDM"},{"code":"300","type":"RC"},{"code":"80074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":654,"maximum":654,"gross_charge":818,"discounted_cash":818,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":654}]}]},{"description":"X Ray Humerus Minimum Of 2 Views Rt","code_information":[{"code":"5000328","type":"CDM"},{"code":"359","type":"RC"},{"code":"73060","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":654,"maximum":654,"gross_charge":818,"discounted_cash":818,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":654}]}]},{"description":"X Ray Humerus Minimum Of 2 Views Lt","code_information":[{"code":"5000329","type":"CDM"},{"code":"359","type":"RC"},{"code":"73060","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":654,"maximum":654,"gross_charge":818,"discounted_cash":818,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":654}]}]},{"description":"X Ray Humerus Minimum Of 2 Views","code_information":[{"code":"8401478","type":"CDM"},{"code":"359","type":"RC"},{"code":"73060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":654,"maximum":654,"gross_charge":818,"discounted_cash":818,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":654}]}]},{"description":"Inj Trigger Point 3/> Muscl","code_information":[{"code":"1000170","type":"CDM"},{"code":"450","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":651,"maximum":924,"gross_charge":814,"discounted_cash":814,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":651}]}]},{"description":"Excision Nail Matrix Permanent Removal","code_information":[{"code":"8400091","type":"CDM"},{"code":"450","type":"RC"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":650,"maximum":924,"gross_charge":813,"discounted_cash":813,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":650},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":650},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":650}]}]},{"description":"Repair Complex S/a/l 2.6 Cm-7.5 Cm","code_information":[{"code":"8500123","type":"CDM"},{"code":"13121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":649,"maximum":1232,"gross_charge":811,"discounted_cash":811,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":649}]}]},{"description":"Medartis Gold Cortex Bone Screw 08mm","code_information":[{"code":"2800751","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":649,"maximum":649,"gross_charge":811,"discounted_cash":811,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":649}]}]},{"description":"Medartis Gold Cortex Bone Screw 09mm","code_information":[{"code":"2800752","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":649,"maximum":649,"gross_charge":811,"discounted_cash":811,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":649}]}]},{"description":"Medartis 1.5x4mm Cortex Bone Screw","code_information":[{"code":"2800814","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":649,"maximum":649,"gross_charge":811,"discounted_cash":811,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":649}]}]},{"description":"Ngt Placement","code_information":[{"code":"2201936","type":"CDM"},{"code":"220","type":"RC"},{"code":"43752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":647,"maximum":1058,"gross_charge":809,"discounted_cash":809,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":647},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":647},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":647}]}]},{"description":"Blepharotomy Drg Absc Eyelid","code_information":[{"code":"8400340","type":"CDM"},{"code":"450","type":"RC"},{"code":"67700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":644,"maximum":924,"gross_charge":805,"discounted_cash":805,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":644}]}]},{"description":"Remove Eyelid Foreign Body","code_information":[{"code":"8400341","type":"CDM"},{"code":"450","type":"RC"},{"code":"67938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":644,"maximum":924,"gross_charge":805,"discounted_cash":805,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":644}]}]},{"description":"Tenotomy Extensor Hand/fingr Open Ea Tdn","code_information":[{"code":"8500193","type":"CDM"},{"code":"26460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":643,"maximum":1232,"gross_charge":804,"discounted_cash":804,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":643},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":643},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":643}]}]},{"description":"X Ray Wrist Complete Minimum Of 3 Views","code_information":[{"code":"8401484","type":"CDM"},{"code":"359","type":"RC"},{"code":"73110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":642,"maximum":642,"gross_charge":803,"discounted_cash":803,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":642}]}]},{"description":"Drainage Of Finger Abscess","code_information":[{"code":"8500189","type":"CDM"},{"code":"26011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":642,"maximum":924,"gross_charge":802,"discounted_cash":802,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":642}]}]},{"description":"App Cast Shoulder-hand Long Arm","code_information":[{"code":"1000125","type":"CDM"},{"code":"450","type":"RC"},{"code":"29065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":641,"maximum":641,"gross_charge":801,"discounted_cash":801,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":641}]}]},{"description":"Dstrj Nulyt Oth Prph Nrv/branch","code_information":[{"code":"8500333","type":"CDM"},{"code":"64640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":640,"maximum":924,"gross_charge":800,"discounted_cash":800,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":640}]}]},{"description":"Electroencephalogram Eeg Monitor4160 Min","code_information":[{"code":"2200859","type":"CDM"},{"code":"740","type":"RC"},{"code":"95812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":640,"maximum":2300,"gross_charge":800,"discounted_cash":800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Stryker 6.5mmx80mm Cannulated Screw","code_information":[{"code":"2800447","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":640,"maximum":640,"gross_charge":800,"discounted_cash":800,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":640}]}]},{"description":"Stryker Lockeing Screw Full Thread 3.5mm","code_information":[{"code":"2800508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":638,"maximum":638,"gross_charge":798,"discounted_cash":798,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":638}]}]},{"description":"X Ray Facial Bones Less Than 3 Views","code_information":[{"code":"8401429","type":"CDM"},{"code":"359","type":"RC"},{"code":"70140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":636,"maximum":636,"gross_charge":795,"discounted_cash":795,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":636}]}]},{"description":"Nerve Conduction Studies 12 Studies","code_information":[{"code":"2201910","type":"CDM"},{"code":"740","type":"RC"},{"code":"95907","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":633,"maximum":2300,"gross_charge":791,"discounted_cash":791,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Dressing Change Not For Burn","code_information":[{"code":"1000102","type":"CDM"},{"code":"450","type":"RC"},{"code":"15852","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":633,"maximum":924,"gross_charge":791,"discounted_cash":791,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":633}]}]},{"description":"Dressing Change Under Anesthesia","code_information":[{"code":"8400131","type":"CDM"},{"code":"450","type":"RC"},{"code":"15852","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":633,"maximum":924,"gross_charge":791,"discounted_cash":791,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":633}]}]},{"description":"Removal Foreign Body Mouth","code_information":[{"code":"8400284","type":"CDM"},{"code":"450","type":"RC"},{"code":"40804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":633,"maximum":633,"gross_charge":791,"discounted_cash":791,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":633}]}]},{"description":"Rpr Lac 2.5 Cm/< Flr Mth&/ant 2-3rd Tng","code_information":[{"code":"8400285","type":"CDM"},{"code":"450","type":"RC"},{"code":"41250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":633,"maximum":1058,"gross_charge":791,"discounted_cash":791,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":633}]}]},{"description":"Strapping Hip","code_information":[{"code":"1000269","type":"CDM"},{"code":"450","type":"RC"},{"code":"29520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":633,"maximum":633,"gross_charge":791,"discounted_cash":791,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":633}]}]},{"description":"Acumed  10x1.5 Lag Screw","code_information":[{"code":"2800758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":632,"maximum":632,"gross_charge":790,"discounted_cash":790,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":632}]}]},{"description":"Acumed  11.5x8 Lag Screw","code_information":[{"code":"28007564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":632,"maximum":632,"gross_charge":790,"discounted_cash":790,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":632}]}]},{"description":"Clsd Tx Patellar Fract Wo Manip","code_information":[{"code":"8500211","type":"CDM"},{"code":"27520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":632,"maximum":924,"gross_charge":790,"discounted_cash":790,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":632}]}]},{"description":"I&d Vulva/prnl Absc","code_information":[{"code":"8400311","type":"CDM"},{"code":"450","type":"RC"},{"code":"56405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":629,"maximum":1058,"gross_charge":786,"discounted_cash":786,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":629}]}]},{"description":"Observation Care Same Day High Complex","code_information":[{"code":"8500419","type":"CDM"},{"code":"99236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":627,"maximum":627,"gross_charge":784,"discounted_cash":784,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":627},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":627},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":627}]}]},{"description":"Clsd Tx Mcp Disloc Sngl W/man Wo/anes","code_information":[{"code":"8500200","type":"CDM"},{"code":"26705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625,"maximum":1058,"gross_charge":781,"discounted_cash":781,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":625},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":625},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":625}]}]},{"description":"Repair Inter F/e/e/n/l/m&/muc 2.5 Cm/<","code_information":[{"code":"8400115","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":623,"maximum":924,"gross_charge":779,"discounted_cash":779,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":623}]}]},{"description":"Fluoroguided Central Venous Access Dev","code_information":[{"code":"5000081","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":623,"maximum":623,"gross_charge":779,"discounted_cash":779,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":623}]}]},{"description":"X Ray Forearm 2 Views","code_information":[{"code":"8401481","type":"CDM"},{"code":"359","type":"RC"},{"code":"73090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":622,"maximum":622,"gross_charge":778,"discounted_cash":778,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":622}]}]},{"description":"Clsd Tx Carpal Bone Fract W/manip","code_information":[{"code":"8500185","type":"CDM"},{"code":"25635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":622,"maximum":924,"gross_charge":778,"discounted_cash":778,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":622}]}]},{"description":"Rem Fb Musc/tend Sheath Deep Or Comp","code_information":[{"code":"8500141","type":"CDM"},{"code":"20525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":618,"maximum":1232,"gross_charge":773,"discounted_cash":773,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":618}]}]},{"description":"Removal Of Foreign Body Foot Complicated","code_information":[{"code":"8500227","type":"CDM"},{"code":"28193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":618,"maximum":1508,"gross_charge":772,"discounted_cash":772,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":618}]}]},{"description":"Synthes 1.3x6mkm Scrw","code_information":[{"code":"2800559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":616,"maximum":616,"gross_charge":770,"discounted_cash":770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":616}]}]},{"description":".7m C Bone Screw","code_information":[{"code":"2800795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":616,"maximum":616,"gross_charge":770,"discounted_cash":770,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":616}]}]},{"description":"X Ray Spine Cervical 2 Or 3 Views","code_information":[{"code":"8401455","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":610,"maximum":610,"gross_charge":762,"discounted_cash":762,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":610},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":610},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":610}]}]},{"description":"Aspiration And/or Inj Ganglion Cysts","code_information":[{"code":"1000006","type":"CDM"},{"code":"450","type":"RC"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":610,"maximum":924,"gross_charge":762,"discounted_cash":762,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":610},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":610},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":610}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"8500203","type":"CDM"},{"code":"26742","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":608,"maximum":1058,"gross_charge":760,"discounted_cash":760,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":608}]}]},{"description":"Clsd Tx Ankle Dislocation Wo Anes","code_information":[{"code":"8500224","type":"CDM"},{"code":"27840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":608,"maximum":924,"gross_charge":760,"discounted_cash":760,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":608}]}]},{"description":"X Ray Knee 3 Views","code_information":[{"code":"8401500","type":"CDM"},{"code":"329","type":"RC"},{"code":"73562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":607,"maximum":607,"gross_charge":759,"discounted_cash":759,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":607}]}]},{"description":"Fine Needle Aspiration Wo Imaging Guid","code_information":[{"code":"8400066","type":"CDM"},{"code":"450","type":"RC"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":607,"maximum":924,"gross_charge":759,"discounted_cash":759,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":607}]}]},{"description":"Inj Tendon Origin/insertion","code_information":[{"code":"1000171","type":"CDM"},{"code":"450","type":"RC"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":606,"maximum":924,"gross_charge":758,"discounted_cash":758,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":606}]}]},{"description":"X Ray Orbits Complete Minimum Of 4 Views","code_information":[{"code":"8401432","type":"CDM"},{"code":"359","type":"RC"},{"code":"70200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":606,"maximum":606,"gross_charge":758,"discounted_cash":758,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":606}]}]},{"description":"Drain/inj Mjr Joint/bursa W/o Us","code_information":[{"code":"1000004","type":"CDM"},{"code":"450","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":606,"maximum":924,"gross_charge":757,"discounted_cash":757,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":606}]}]},{"description":"Clsd Tx Medial Malleolus Fract Wo Manip","code_information":[{"code":"8500216","type":"CDM"},{"code":"27760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":604,"maximum":924,"gross_charge":755,"discounted_cash":755,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":604}]}]},{"description":"Nutrition Therapy","code_information":[{"code":"7000001","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":604,"gross_charge":755,"discounted_cash":755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":100}]}]},{"description":"Xr Spine Thoracolumbar Junct Min 2 Vw","code_information":[{"code":"8401461","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":604,"maximum":604,"gross_charge":755,"discounted_cash":755,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":604}]}]},{"description":"Prolactin","code_information":[{"code":"4000326","type":"CDM"},{"code":"300","type":"RC"},{"code":"84146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":603,"maximum":603,"gross_charge":754,"discounted_cash":754,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":603},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":603},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":603}]}]},{"description":"Protein Electrophoretic Fractionation","code_information":[{"code":"4000331","type":"CDM"},{"code":"306","type":"RC"},{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":603,"maximum":603,"gross_charge":754,"discounted_cash":754,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":603},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":603},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":603}]}]},{"description":"Tetanus Immune Globulin Inj","code_information":[{"code":"8400906","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":602,"maximum":602,"gross_charge":753,"discounted_cash":753,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":602}]}]},{"description":"Radiologic Examination, Knee; Both Knees","code_information":[{"code":"2401502","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Corelink Pre-bent Rod 40mm","code_information":[{"code":"2800141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Ctl Amedica Picasso Ii Curved Rod 06.0xl","code_information":[{"code":"2800149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Synthes 1.3mm X12mm Screw","code_information":[{"code":"2800558","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Synthes 1.6x6mm Screw","code_information":[{"code":"2800568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Tl Amedica Curved Rod .6x40mm","code_information":[{"code":"2800667","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Guide Wire","code_information":[{"code":"28000747","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Introducer/sheath, Other Than Guiding, O","code_information":[{"code":"81000008","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Xr Hips Unilateral W/pelvis 2-3 Views","code_information":[{"code":"8401490","type":"CDM"},{"code":"329","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":600,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Drg Absc Cst Hmtma Dentoalveolar Struxs","code_information":[{"code":"8400288","type":"CDM"},{"code":"450","type":"RC"},{"code":"41800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":599,"maximum":924,"gross_charge":749,"discounted_cash":749,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":599}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"1000205","type":"CDM"},{"code":"450","type":"RC"},{"code":"65220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":595,"maximum":595,"gross_charge":744,"discounted_cash":744,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":595}]}]},{"description":"Nasal/orogastric W/tube Plmt","code_information":[{"code":"1000188","type":"CDM"},{"code":"450","type":"RC"},{"code":"43752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":595,"maximum":1058,"gross_charge":744,"discounted_cash":744,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":595}]}]},{"description":"Asnis 2.0mm Microcannulated Screw 11/5mm","code_information":[{"code":"2800110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":594,"maximum":594,"gross_charge":742,"discounted_cash":742,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":594}]}]},{"description":"Asnis Micro Cannulated Screw 2.0x18mm","code_information":[{"code":"2800111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":594,"maximum":594,"gross_charge":742,"discounted_cash":742,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":594}]}]},{"description":"Stryker 40-20112 2.0mm Asnis Micro Cannu","code_information":[{"code":"2800440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":594,"maximum":594,"gross_charge":742,"discounted_cash":742,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":594}]}]},{"description":"Stryker Micro Cannulated Screw 2.0 X 16m","code_information":[{"code":"2800535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":594,"maximum":594,"gross_charge":742,"discounted_cash":742,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":594}]}]},{"description":"Nerve Conduction Studies 34 Studies","code_information":[{"code":"2201911","type":"CDM"},{"code":"740","type":"RC"},{"code":"95908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":592,"maximum":2300,"gross_charge":740,"discounted_cash":740,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"23x24 Locking Screw","code_information":[{"code":"2800006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":592,"maximum":592,"gross_charge":740,"discounted_cash":740,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":592}]}]},{"description":"X Ray Ankle Complete Minimum Of 3 Views","code_information":[{"code":"8401506","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":591,"maximum":591,"gross_charge":739,"discounted_cash":739,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":591}]}]},{"description":"Stryker Locking Screw 3.0x24mm","code_information":[{"code":"2800512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":591,"maximum":591,"gross_charge":739,"discounted_cash":739,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":591}]}]},{"description":"Stryker Anchor Locking Screw 3mmx10mm","code_information":[{"code":"2800755","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":738,"discounted_cash":738,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Stryker Anchor Locking Screw 3mmx22mm","code_information":[{"code":"2800756","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":738,"discounted_cash":738,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Stryker 3.5 X22 Screw","code_information":[{"code":"2800437","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":737,"discounted_cash":737,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Stryker Anchor Locking Screw 3mmx12mm","code_information":[{"code":"2800452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":737,"discounted_cash":737,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Stryker Anchor Locking Screw 3x26mm","code_information":[{"code":"2800453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":737,"discounted_cash":737,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Stryker Anchor Locking Screw 3x28mm","code_information":[{"code":"2800454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":737,"discounted_cash":737,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Stryker Anchor Locking Screw 3x30mm","code_information":[{"code":"2800455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":737,"discounted_cash":737,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Stryker Anchorage Lckg Screw 3.5mm X12mm","code_information":[{"code":"2800463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":737,"discounted_cash":737,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Stryker Anchorage Standards Screw 3x18","code_information":[{"code":"2800467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":590,"gross_charge":737,"discounted_cash":737,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Ob Us Nuchal Meas 1 Gest","code_information":[{"code":"8401387","type":"CDM"},{"code":"402","type":"RC"},{"code":"76813","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":588,"maximum":588,"gross_charge":735,"discounted_cash":735,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":588}]}]},{"description":"Stryker Anchor Locking Screw 3mm X 20mm","code_information":[{"code":"2800451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":588,"maximum":588,"gross_charge":735,"discounted_cash":735,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":588}]}]},{"description":"Emer Dept Low To Moderate Severity","code_information":[{"code":"8500421","type":"CDM"},{"code":"99282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":588,"maximum":588,"gross_charge":735,"discounted_cash":735,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":588}]}]},{"description":"Inj Tendon Sheath/ligament","code_information":[{"code":"1000172","type":"CDM"},{"code":"450","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":586,"maximum":924,"gross_charge":733,"discounted_cash":733,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":586}]}]},{"description":"Iv Hydration Initial","code_information":[{"code":"3100008","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":586,"gross_charge":733,"discounted_cash":733,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Rep Cmp Eyelid/nose/ear/lip 2.6-7.5 Cm","code_information":[{"code":"8500129","type":"CDM"},{"code":"13152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":585,"maximum":1232,"gross_charge":731,"discounted_cash":731,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":585},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":585},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":585}]}]},{"description":"Xr Abd 2 Views","code_information":[{"code":"5000216","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":584,"maximum":584,"gross_charge":730,"discounted_cash":730,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":584},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":584},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":584}]}]},{"description":"X-ray Exam Abdomen 2 Views","code_information":[{"code":"8401515","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":584,"maximum":584,"gross_charge":730,"discounted_cash":730,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":584},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":584},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":584}]}]},{"description":"Stryker 6.5mmx70mm Cannulated Screw","code_information":[{"code":"2800446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":582,"maximum":582,"gross_charge":728,"discounted_cash":728,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":582},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":582},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":582}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"1000213","type":"CDM"},{"code":"450","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":578,"maximum":578,"gross_charge":723,"discounted_cash":723,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":578}]}]},{"description":"Treat Clavicle Fracture","code_information":[{"code":"8500162","type":"CDM"},{"code":"23505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":578,"maximum":924,"gross_charge":723,"discounted_cash":723,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":578}]}]},{"description":"Aqt Hep Panel","code_information":[{"code":"8400455","type":"CDM"},{"code":"300","type":"RC"},{"code":"80074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":578,"maximum":578,"gross_charge":722,"discounted_cash":722,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":578}]}]},{"description":"X Ray Clavicle Complete","code_information":[{"code":"8401472","type":"CDM"},{"code":"359","type":"RC"},{"code":"73000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":578,"maximum":578,"gross_charge":722,"discounted_cash":722,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":578}]}]},{"description":"Iv Push Initial","code_information":[{"code":"3100002","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":576,"gross_charge":720,"discounted_cash":720,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Blood test, comprehensive group of blood chemicals","code_information":[{"code":"4000259","type":"CDM"},{"code":"301","type":"RC"},{"code":"80053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570,"maximum":570,"gross_charge":713,"discounted_cash":713,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":570}]}]},{"description":"Blood test, comprehensive group of blood chemicals","code_information":[{"code":"8400453","type":"CDM"},{"code":"301","type":"RC"},{"code":"80053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570,"maximum":570,"gross_charge":713,"discounted_cash":713,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":570}]}]},{"description":"Sars-cov-2 Nec","code_information":[{"code":"4000335","type":"CDM"},{"code":"300","type":"RC"},{"code":"0240U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570,"maximum":570,"gross_charge":713,"discounted_cash":713,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":570}]}]},{"description":"Infect Dis Path 3 Targets","code_information":[{"code":"8400447","type":"CDM"},{"code":"300","type":"RC"},{"code":"0240U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570,"maximum":570,"gross_charge":713,"discounted_cash":713,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":570}]}]},{"description":"Treat Thumb Dislocation","code_information":[{"code":"8500198","type":"CDM"},{"code":"26641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570,"maximum":570,"gross_charge":712,"discounted_cash":712,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":570}]}]},{"description":"Bed Side Change Of Cystostomy Tube Smpl","code_information":[{"code":"2200339","type":"CDM"},{"code":"761","type":"RC"},{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570,"maximum":924,"gross_charge":712,"discounted_cash":712,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":570}]}]},{"description":"X Ray Ribs Unilateral 2 Views","code_information":[{"code":"8401449","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":569,"maximum":569,"gross_charge":711,"discounted_cash":711,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":569},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":569},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":569}]}]},{"description":"Parathormone Parathyroid Hormone","code_information":[{"code":"4000304","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":567,"maximum":567,"gross_charge":709,"discounted_cash":709,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":567}]}]},{"description":"Intubation Endotracheal Emergency Proced","code_information":[{"code":"8400261","type":"CDM"},{"code":"450","type":"RC"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":566,"maximum":924,"gross_charge":708,"discounted_cash":708,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":566}]}]},{"description":"Tracheotomy Tube Change","code_information":[{"code":"8400262","type":"CDM"},{"code":"450","type":"RC"},{"code":"31502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":566,"maximum":924,"gross_charge":708,"discounted_cash":708,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":566}]}]},{"description":"Ertapenem (Invanz) 1gm Vl","code_information":[{"code":"3000128","type":"CDM"},{"code":"636","type":"RC"},{"code":"63843","type":"CPT","modifier":"71"}],"standard_charges":[{"setting":"outpatient","modifier_code":["71"],"minimum":566,"maximum":566,"gross_charge":708,"discounted_cash":708,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":566}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Drainage Of Skin Abscess","code_information":[{"code":"600002","type":"CDM"},{"code":"220","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":563,"maximum":924,"gross_charge":704,"discounted_cash":704,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":563},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":563},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":563}]}]},{"description":"Simple Repair F/e/e/n/l/m 12.6cm-20.0cm","code_information":[{"code":"8400104","type":"CDM"},{"code":"450","type":"RC"},{"code":"12016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":562,"maximum":1058,"gross_charge":703,"discounted_cash":703,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":562}]}]},{"description":"Neuromuscular Junction Testing","code_information":[{"code":"2201915","type":"CDM"},{"code":"922","type":"RC"},{"code":"95937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":560,"gross_charge":700,"discounted_cash":700,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":409}]}]},{"description":"Established 10-9 Min","code_information":[{"code":"6100075","type":"CDM"},{"code":"424","type":"RC"},{"code":"99212","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":225,"maximum":559,"gross_charge":699,"discounted_cash":699,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Established 10-9 Min","code_information":[{"code":"6100076","type":"CDM"},{"code":"424","type":"RC"},{"code":"99212","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":225,"maximum":559,"gross_charge":699,"discounted_cash":699,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Njx Anes Trigeminal Nrv Any Div/branch","code_information":[{"code":"8500320","type":"CDM"},{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":559,"maximum":924,"gross_charge":699,"discounted_cash":699,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":559}]}]},{"description":"Inj Trigger Point 1-2 Muscl","code_information":[{"code":"1000169","type":"CDM"},{"code":"450","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":559,"maximum":924,"gross_charge":699,"discounted_cash":699,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":559}]}]},{"description":"Njx Sclrsnt 1 Incmptnt Vein","code_information":[{"code":"2201443","type":"CDM"},{"code":"360","type":"RC"},{"code":"36470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":558,"maximum":924,"gross_charge":698,"discounted_cash":698,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":558}]}]},{"description":"Repair Complex S/a/l Ea 5 Cm Or Less","code_information":[{"code":"8400124","type":"CDM"},{"code":"450","type":"RC"},{"code":"13122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":558,"maximum":924,"gross_charge":697,"discounted_cash":697,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":558}]}]},{"description":"Stryker 1.7 X 6 Locking Screw","code_information":[{"code":"2800421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":557,"maximum":557,"gross_charge":696,"discounted_cash":696,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":557},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":557},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":557}]}]},{"description":"Stryker 1.7 X5 Locking Screw","code_information":[{"code":"2800423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":557,"maximum":557,"gross_charge":696,"discounted_cash":696,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":557},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":557},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":557}]}]},{"description":"X Ray Foot 2 Views","code_information":[{"code":"8401508","type":"CDM"},{"code":"359","type":"RC"},{"code":"73620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":556,"maximum":556,"gross_charge":695,"discounted_cash":695,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":556}]}]},{"description":"Stryker Self Drilling Half Pin","code_information":[{"code":"2800545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":555,"maximum":555,"gross_charge":694,"discounted_cash":694,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":555},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":555},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":555}]}]},{"description":"Drain/inj Joint/bursa W/o Us","code_information":[{"code":"1000005","type":"CDM"},{"code":"450","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Inj Anes Agent Sphenopalatine Ganglion","code_information":[{"code":"1000164","type":"CDM"},{"code":"450","type":"RC"},{"code":"64505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"N Block Inj Plantar Digit","code_information":[{"code":"1000168","type":"CDM"},{"code":"450","type":"RC"},{"code":"64455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Arthrocentesis Aspir&/inj Inter Jt/bursa","code_information":[{"code":"8400146","type":"CDM"},{"code":"450","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Arthrocentesis Aspir&/inj Inter Jt/bursa","code_information":[{"code":"8400147","type":"CDM"},{"code":"450","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Arthrocentesis Aspir&/inj Mjr Jt/ Bursa","code_information":[{"code":"8400149","type":"CDM"},{"code":"450","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Arthrocentesis Aspir&/inj Mjr Jt/ Bursa","code_information":[{"code":"8400150","type":"CDM"},{"code":"450","type":"RC"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Aspirate/inj Ganglion Cyst","code_information":[{"code":"8400151","type":"CDM"},{"code":"450","type":"RC"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"N Block Inj Plantar Digit","code_information":[{"code":"8400329","type":"CDM"},{"code":"450","type":"RC"},{"code":"64455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Inj Anes Agent Sphenopalatine Ganglion","code_information":[{"code":"8400330","type":"CDM"},{"code":"450","type":"RC"},{"code":"64505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"X Ray Scapula Complete","code_information":[{"code":"8401473","type":"CDM"},{"code":"359","type":"RC"},{"code":"73010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":554,"gross_charge":692,"discounted_cash":692,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Rep Cmp Eyelid/nose/ear/lip 1.1-2.5 Cm","code_information":[{"code":"8500128","type":"CDM"},{"code":"13151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":1232,"gross_charge":692,"discounted_cash":692,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Clsd Tx Prox Fibula/shaft Fract Wo/manip","code_information":[{"code":"8500218","type":"CDM"},{"code":"27780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":924,"gross_charge":692,"discounted_cash":692,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Clsd Tx Metacarpal Fract Single W/manip","code_information":[{"code":"8500196","type":"CDM"},{"code":"26605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":552,"maximum":1058,"gross_charge":690,"discounted_cash":690,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":552}]}]},{"description":"Avulsion Nail Plate Partial Or Comp","code_information":[{"code":"1000007","type":"CDM"},{"code":"450","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":551,"maximum":924,"gross_charge":689,"discounted_cash":689,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":551}]}]},{"description":"Avulsion Nail Plate Prtl Cmp Ea Addtl","code_information":[{"code":"8400089","type":"CDM"},{"code":"450","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":551,"maximum":924,"gross_charge":689,"discounted_cash":689,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":551}]}]},{"description":"Tx Closed Elbow Dislocation Wo/anes","code_information":[{"code":"8500171","type":"CDM"},{"code":"24600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550,"maximum":924,"gross_charge":688,"discounted_cash":688,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":550},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":550},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":550}]}]},{"description":"Clsd Tx Patellar Dislocation Wo Anes","code_information":[{"code":"8500213","type":"CDM"},{"code":"27560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":548,"maximum":924,"gross_charge":685,"discounted_cash":685,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":548}]}]},{"description":"Xr Ac Joints Bilateral W/wo Wt Distr","code_information":[{"code":"8401477","type":"CDM"},{"code":"359","type":"RC"},{"code":"73050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":548,"maximum":548,"gross_charge":685,"discounted_cash":685,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":548}]}]},{"description":"Transfusion Blood Or Blood Components","code_information":[{"code":"2202834","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT","modifier":"BL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BL"],"minimum":125,"maximum":548,"gross_charge":685,"discounted_cash":685,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":125}]}]},{"description":"Depuy Bone Cement 20 G","code_information":[{"code":"2800170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":546,"maximum":546,"gross_charge":682,"discounted_cash":682,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":546}]}]},{"description":"Inf Agent Det By Immunoassay N Gonorrhae","code_information":[{"code":"4000216","type":"CDM"},{"code":"300","type":"RC"},{"code":"87850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":542,"maximum":542,"gross_charge":677,"discounted_cash":677,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":542}]}]},{"description":"Strapping Unna Boot","code_information":[{"code":"1000273","type":"CDM"},{"code":"450","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":542,"gross_charge":677,"discounted_cash":677,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"X Ray Chest 2 Views Frontal And Lateral","code_information":[{"code":"8401441","type":"CDM"},{"code":"359","type":"RC"},{"code":"71020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":542,"maximum":542,"gross_charge":677,"discounted_cash":677,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":542}]}]},{"description":"Usg For Aspiration Ova","code_information":[{"code":"5000180","type":"CDM"},{"code":"402","type":"RC"},{"code":"76948","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":541,"maximum":541,"gross_charge":676,"discounted_cash":676,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":541}]}]},{"description":"X Ray Elbow 2 Views","code_information":[{"code":"8401479","type":"CDM"},{"code":"359","type":"RC"},{"code":"73070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":540,"maximum":540,"gross_charge":675,"discounted_cash":675,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":540}]}]},{"description":"Clsd Tx Phalangeal Shaft Fract W/ma","code_information":[{"code":"8500202","type":"CDM"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":539,"maximum":1058,"gross_charge":674,"discounted_cash":674,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":539}]}]},{"description":"Xr Sacrum And Coccyx Minimum Of 2 Vw","code_information":[{"code":"8401469","type":"CDM"},{"code":"359","type":"RC"},{"code":"72220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":538,"maximum":538,"gross_charge":673,"discounted_cash":673,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":538}]}]},{"description":"Clsd Tx Radial/ulnar Shaft Fract Wo/man","code_information":[{"code":"8500179","type":"CDM"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":538,"maximum":924,"gross_charge":673,"discounted_cash":673,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":538}]}]},{"description":"Xr Nasal Bones Complete Min 3 Vw","code_information":[{"code":"8401431","type":"CDM"},{"code":"359","type":"RC"},{"code":"70160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":537,"maximum":537,"gross_charge":671,"discounted_cash":671,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":537},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":537},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":537}]}]},{"description":"Chest Tube Tray Centurion","code_information":[{"code":"8401230","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CHTU"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CHTU"],"minimum":536,"maximum":536,"gross_charge":670,"discounted_cash":670,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":536}]}]},{"description":"Chest Tube Tray Cook 36 Fr","code_information":[{"code":"8401231","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CHTU2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CHTU2"],"minimum":536,"maximum":536,"gross_charge":670,"discounted_cash":670,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":536}]}]},{"description":"X Ray Shoulder 1 View","code_information":[{"code":"8401474","type":"CDM"},{"code":"359","type":"RC"},{"code":"73020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":535,"maximum":535,"gross_charge":669,"discounted_cash":669,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":535}]}]},{"description":"X Ray Ribs Bilateral 3 Views","code_information":[{"code":"8401451","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":535,"maximum":535,"gross_charge":669,"discounted_cash":669,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":535}]}]},{"description":"Initial Observation Care High Complexity","code_information":[{"code":"8400416","type":"CDM"},{"code":"450","type":"RC"},{"code":"99220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":534,"maximum":534,"gross_charge":668,"discounted_cash":668,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":534}]}]},{"description":"Initial Observation Care High Complexity","code_information":[{"code":"8500416","type":"CDM"},{"code":"99220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":534,"maximum":534,"gross_charge":668,"discounted_cash":668,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":534}]}]},{"description":"Ofloxacin 3mg/ml","code_information":[{"code":"3000223","type":"CDM"},{"code":"636","type":"RC"},{"code":"60505036301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":534,"maximum":534,"gross_charge":668,"discounted_cash":668,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":534}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Radiation Physics Consult","code_information":[{"code":"5000056","type":"CDM"},{"code":"999","type":"RC"},{"code":"77336","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":534,"maximum":534,"gross_charge":667,"discounted_cash":667,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":534}]}]},{"description":"X Ray Exam Hips Bilateral Min 2 Views","code_information":[{"code":"8401492","type":"CDM"},{"code":"329","type":"RC"},{"code":"73520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":533,"maximum":533,"gross_charge":666,"discounted_cash":666,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":533}]}]},{"description":"Remove Impacted Ear Wax Uni","code_information":[{"code":"1000197","type":"CDM"},{"code":"450","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":531,"maximum":924,"gross_charge":664,"discounted_cash":664,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":531}]}]},{"description":"Xr Skull Limited","code_information":[{"code":"5000314","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":530,"maximum":530,"gross_charge":662,"discounted_cash":662,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":530}]}]},{"description":"X Ray Skull Less Than 4 Views","code_information":[{"code":"8401435","type":"CDM"},{"code":"359","type":"RC"},{"code":"70250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":530,"maximum":530,"gross_charge":662,"discounted_cash":662,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":530}]}]},{"description":"Rep Cmp F/c/c/m/n/ax/g/h/f 2.6 Cm-7.5 Cm","code_information":[{"code":"8500126","type":"CDM"},{"code":"13132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":528,"maximum":1232,"gross_charge":660,"discounted_cash":660,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":528}]}]},{"description":"Xr Chest 1 View","code_information":[{"code":"5000211","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":528,"maximum":528,"gross_charge":660,"discounted_cash":660,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":528}]}]},{"description":"X Ray Chest Single View Frontal","code_information":[{"code":"8401445","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":528,"maximum":528,"gross_charge":660,"discounted_cash":660,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":528}]}]},{"description":"Stryker 1.7mm Bishell Plate","code_information":[{"code":"2800425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":528,"maximum":528,"gross_charge":660,"discounted_cash":660,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":528}]}]},{"description":"Intra-atrial Pacing","code_information":[{"code":"8500372","type":"CDM"},{"code":"93610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":527,"gross_charge":659,"discounted_cash":659,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"X Ray Femur 1 View","code_information":[{"code":"8401497","type":"CDM"},{"code":"329","type":"RC"},{"code":"73551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":527,"maximum":527,"gross_charge":659,"discounted_cash":659,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":527}]}]},{"description":"Njx Anes Facial Nrv","code_information":[{"code":"8500321","type":"CDM"},{"code":"64402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":526,"maximum":526,"gross_charge":658,"discounted_cash":658,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":526}]}]},{"description":"N Block Stellate Ganglion","code_information":[{"code":"8500331","type":"CDM"},{"code":"64510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":526,"maximum":924,"gross_charge":658,"discounted_cash":658,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":526}]}]},{"description":"Tomosynthesis","code_information":[{"code":"5100070","type":"CDM"},{"code":"403","type":"RC"},{"code":"77063","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":526,"maximum":526,"gross_charge":657,"discounted_cash":657,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":526}]}]},{"description":"Tomosynthesis Unilater","code_information":[{"code":"5100073","type":"CDM"},{"code":"761","type":"RC"},{"code":"77061","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":526,"maximum":526,"gross_charge":657,"discounted_cash":657,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":526}]}]},{"description":"Diag Tomosyntesis Bilateral","code_information":[{"code":"5100075","type":"CDM"},{"code":"761","type":"RC"},{"code":"77062","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":526,"maximum":526,"gross_charge":657,"discounted_cash":657,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":526}]}]},{"description":"Xr Upper Extremity Infant Min 2 Vw","code_information":[{"code":"8401482","type":"CDM"},{"code":"359","type":"RC"},{"code":"73092","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":526,"maximum":526,"gross_charge":657,"discounted_cash":657,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":526}]}]},{"description":"Xr Lower Extremity Infant Min 2 Vw","code_information":[{"code":"8401504","type":"CDM"},{"code":"329","type":"RC"},{"code":"73592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":526,"maximum":526,"gross_charge":657,"discounted_cash":657,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":526}]}]},{"description":"Clsd Tx Tibial Shaft Fract Wo Manip","code_information":[{"code":"8500214","type":"CDM"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":525,"maximum":924,"gross_charge":656,"discounted_cash":656,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":525}]}]},{"description":"Acumed Hexalo0be Screw 3.5 X 10 Mm","code_information":[{"code":"2800050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":524,"maximum":524,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":524}]}]},{"description":"Acumed Hexalob Screw","code_information":[{"code":"2800777","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":524,"maximum":524,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":524}]}]},{"description":"Acumed 3.5x20mm Nl Screw","code_information":[{"code":"2800797","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":524,"maximum":524,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":524}]}]},{"description":"Acumed 3.0x16 Hexalobe Screw","code_information":[{"code":"2800811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":524,"maximum":524,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":524}]}]},{"description":"Removal Of Foot Foreign Body/deep","code_information":[{"code":"8500226","type":"CDM"},{"code":"28192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":524,"maximum":1058,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":524}]}]},{"description":"Acumed 3.0x14 Hexa Screw","code_information":[{"code":"28002811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":524,"maximum":524,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":524}]}]},{"description":"X Ray Spine Single View Specify Level","code_information":[{"code":"8401454","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":524,"maximum":524,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":524}]}]},{"description":"Incision&drain Abscess Comp Multiple","code_information":[{"code":"8500069","type":"CDM"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":522,"maximum":924,"gross_charge":653,"discounted_cash":653,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":522}]}]},{"description":"Xr Abd Comp Inc Decubitus &/Or Erect Vw","code_information":[{"code":"8401516","type":"CDM"},{"code":"320","type":"RC"},{"code":"74020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":521,"maximum":521,"gross_charge":651,"discounted_cash":651,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":521}]}]},{"description":"Clsd Tx Distal Fibular Fract Wo Manip","code_information":[{"code":"8500219","type":"CDM"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":521,"maximum":924,"gross_charge":651,"discounted_cash":651,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":521}]}]},{"description":"Simple Rpr S/n/s/g/t 7.6 To12.5cm","code_information":[{"code":"8400097","type":"CDM"},{"code":"450","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":521,"maximum":924,"gross_charge":651,"discounted_cash":651,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":521}]}]},{"description":"Removal Fb Intranasal Office Procedure","code_information":[{"code":"8400257","type":"CDM"},{"code":"450","type":"RC"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":521,"maximum":521,"gross_charge":651,"discounted_cash":651,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":521}]}]},{"description":"Hosp/clinic Visit Spec Collect Covid19","code_information":[{"code":"1000292","type":"CDM"},{"code":"300","type":"RC"},{"code":"C9803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":519,"maximum":519,"gross_charge":649,"discounted_cash":649,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":519}]}]},{"description":"Hosp/clinic Visit Spec Collect Covid19","code_information":[{"code":"8400795","type":"CDM"},{"code":"300","type":"RC"},{"code":"C9803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":519,"maximum":519,"gross_charge":649,"discounted_cash":649,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":519}]}]},{"description":"Treatment Of Penis Lesion","code_information":[{"code":"8400307","type":"CDM"},{"code":"360","type":"RC"},{"code":"54220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":518,"maximum":924,"gross_charge":648,"discounted_cash":648,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":518},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":518},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":518}]}]},{"description":"Radiation Physics Consult","code_information":[{"code":"5000155","type":"CDM"},{"code":"999","type":"RC"},{"code":"77370","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":517,"maximum":517,"gross_charge":646,"discounted_cash":646,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":517}]}]},{"description":"Radiation Therapy Dose Plan","code_information":[{"code":"5000024","type":"CDM"},{"code":"329","type":"RC"},{"code":"77300","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":517,"maximum":517,"gross_charge":646,"discounted_cash":646,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":517}]}]},{"description":"Xr Chest 2 Vw W/apical Lordotic","code_information":[{"code":"8401442","type":"CDM"},{"code":"359","type":"RC"},{"code":"71021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":516,"maximum":516,"gross_charge":645,"discounted_cash":645,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":516}]}]},{"description":"Xr Nose-rectum For Fb Single View Child","code_information":[{"code":"8401523","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":516,"maximum":516,"gross_charge":645,"discounted_cash":645,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":516}]}]},{"description":"Ethicon Mesh 6x6","code_information":[{"code":"2800202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":516,"maximum":516,"gross_charge":645,"discounted_cash":645,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":516}]}]},{"description":"Repair Inter F/e/e/n/l/m&/muc 7.6-12.5cm","code_information":[{"code":"8500118","type":"CDM"},{"code":"12054","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":515,"maximum":1058,"gross_charge":644,"discounted_cash":644,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":515}]}]},{"description":"Us Prg Utrs Rt W/img Dc 1st Trim Ftl Nch","code_information":[{"code":"8401388","type":"CDM"},{"code":"402","type":"RC"},{"code":"76814","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":514,"maximum":514,"gross_charge":643,"discounted_cash":643,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":514}]}]},{"description":"Clsd Tx Distal Rad Fract/epiphyseal Sep","code_information":[{"code":"8500181","type":"CDM"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":511,"maximum":924,"gross_charge":639,"discounted_cash":639,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":511},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":511},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":511}]}]},{"description":"Clsd Tx Proximal Humeral Fract Wo/manip","code_information":[{"code":"8500164","type":"CDM"},{"code":"23600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":507,"maximum":924,"gross_charge":634,"discounted_cash":634,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":507}]}]},{"description":"Evacuation Subungual Hematoma","code_information":[{"code":"1000128","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":505,"maximum":924,"gross_charge":631,"discounted_cash":631,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":505}]}]},{"description":"Xr Abd Anteropost&add Oblique&cone Vw","code_information":[{"code":"8401513","type":"CDM"},{"code":"329","type":"RC"},{"code":"74010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504,"maximum":504,"gross_charge":630,"discounted_cash":630,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":504}]}]},{"description":"Clsd Tx Fract Wt Bear Artclr Prt Dst Tib","code_information":[{"code":"8500222","type":"CDM"},{"code":"27824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":924,"gross_charge":629,"discounted_cash":629,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Synthes 3.5 Locking Screws 54mm","code_information":[{"code":"2800598","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":503,"gross_charge":629,"discounted_cash":629,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Synthes 3.5mm Locking Screws 58mm","code_information":[{"code":"2800606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":503,"gross_charge":629,"discounted_cash":629,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Synthes Locking Screws 10mm","code_information":[{"code":"2800638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":503,"gross_charge":629,"discounted_cash":629,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Clsd Tx Radial Head/neck Fract Wo/manip","code_information":[{"code":"8500173","type":"CDM"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":924,"gross_charge":629,"discounted_cash":629,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Clsd Tx Carpal Bone Fract Wo/manipulat","code_information":[{"code":"8500184","type":"CDM"},{"code":"25630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":924,"gross_charge":629,"discounted_cash":629,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Bone Density Bone Mineral Content Study","code_information":[{"code":"5000031","type":"CDM"},{"code":"343","type":"RC"},{"code":"78351","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":502,"maximum":502,"gross_charge":628,"discounted_cash":628,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":502}]}]},{"description":"Repair Inter F/e/e/n/l/m&/muc 5.1-7.5 Cm","code_information":[{"code":"8500117","type":"CDM"},{"code":"12053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":502,"maximum":924,"gross_charge":628,"discounted_cash":628,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":502}]}]},{"description":"Inpatient Punch Biopsy","code_information":[{"code":"600001","type":"CDM"},{"code":"220","type":"RC"},{"code":"11100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":501,"maximum":501,"gross_charge":626,"discounted_cash":626,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":501}]}]},{"description":"Dbrd W Rmv Fm Fx& Dslc Skn Sbq T M F Msc","code_information":[{"code":"8500078","type":"CDM"},{"code":"11011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":501,"maximum":1058,"gross_charge":626,"discounted_cash":626,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":501}]}]},{"description":"Clsd Tx Mcp Disloc Sngl W/man Wo/anes","code_information":[{"code":"8500199","type":"CDM"},{"code":"26700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":500,"maximum":500,"gross_charge":625,"discounted_cash":625,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":500}]}]},{"description":"Providence Cervical Visualization Harnes","code_information":[{"code":"2800365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":500,"maximum":500,"gross_charge":625,"discounted_cash":625,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":500}]}]},{"description":"Inj F-18 Fdg","code_information":[{"code":"3060820","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":500,"maximum":500,"gross_charge":625,"discounted_cash":625,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":500}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Moderate Sedation Same Phys Qhp>5 Yrs","code_information":[{"code":"2600004","type":"CDM"},{"code":"370","type":"RC"},{"code":"99152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":499,"maximum":499,"gross_charge":624,"discounted_cash":624,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":499}]}]},{"description":"Echo Exam Of Eye Thickness","code_information":[{"code":"5100023","type":"CDM"},{"code":"402","type":"RC"},{"code":"76514","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":497,"maximum":497,"gross_charge":621,"discounted_cash":621,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":497},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":497},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":497}]}]},{"description":"Remove Intrauterine Device","code_information":[{"code":"8400314","type":"CDM"},{"code":"450","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":496,"maximum":924,"gross_charge":620,"discounted_cash":620,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":496}]}]},{"description":"X Ray Sternum Minimum Of 2 Views","code_information":[{"code":"8401453","type":"CDM"},{"code":"359","type":"RC"},{"code":"71120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":495,"maximum":495,"gross_charge":619,"discounted_cash":619,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":495}]}]},{"description":"X Ray Chest Single View Frontal","code_information":[{"code":"8401440","type":"CDM"},{"code":"359","type":"RC"},{"code":"71010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":495,"maximum":495,"gross_charge":619,"discounted_cash":619,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":495}]}]},{"description":"Cc E/m Critically Ill/injured Ea 30 Min","code_information":[{"code":"8500426","type":"CDM"},{"code":"99292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":494,"maximum":494,"gross_charge":618,"discounted_cash":618,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":494},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":494},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":494}]}]},{"description":"Us Abdl Aorta Screen Aaa","code_information":[{"code":"5100033","type":"CDM"},{"code":"402","type":"RC"},{"code":"76706","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":494,"maximum":494,"gross_charge":618,"discounted_cash":618,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":494},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":494},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":494}]}]},{"description":"10mm Bone Screw","code_information":[{"code":"2800794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":493,"maximum":493,"gross_charge":616,"discounted_cash":616,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":493}]}]},{"description":"Inf Agent Antigen Detection By Enzyme","code_information":[{"code":"4000207","type":"CDM"},{"code":"300","type":"RC"},{"code":"87426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":492,"maximum":492,"gross_charge":615,"discounted_cash":615,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":492}]}]},{"description":"Infectious Agent Angtigen Sars Cov2","code_information":[{"code":"8400745","type":"CDM"},{"code":"300","type":"RC"},{"code":"87426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":492,"maximum":492,"gross_charge":615,"discounted_cash":615,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":492}]}]},{"description":"Strapping Ankle And/or Foot","code_information":[{"code":"1000266","type":"CDM"},{"code":"450","type":"RC"},{"code":"29540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":492,"maximum":492,"gross_charge":615,"discounted_cash":615,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":492}]}]},{"description":"Us Dup Scn Up Ext Art/artl Bpg Uni/lmtd","code_information":[{"code":"8401406","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":612,"discounted_cash":612,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Clsd Tx Shldr Dislocation W/manip Wo/ans","code_information":[{"code":"8500166","type":"CDM"},{"code":"23650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":490,"maximum":924,"gross_charge":612,"discounted_cash":612,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":490}]}]},{"description":"Repair Complex S/a/l 1.1 Cm To 2.5 Cm","code_information":[{"code":"8500122","type":"CDM"},{"code":"13120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":489,"maximum":1058,"gross_charge":611,"discounted_cash":611,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":489}]}]},{"description":"Acumed 14mm Non Locking Screw","code_information":[{"code":"2800027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":488,"maximum":488,"gross_charge":610,"discounted_cash":610,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":488}]}]},{"description":"Acumed 16mm X 3.5mm Non Locking Screw","code_information":[{"code":"2800029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":488,"maximum":488,"gross_charge":610,"discounted_cash":610,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":488}]}]},{"description":"Acumed 3.5 12 Cortical","code_information":[{"code":"2800036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":488,"maximum":488,"gross_charge":610,"discounted_cash":610,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":488}]}]},{"description":"Synthes 1.3 X6mm Screw","code_information":[{"code":"2800557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":488,"maximum":488,"gross_charge":610,"discounted_cash":610,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":488}]}]},{"description":"Observation Care Same Day Mod Complex","code_information":[{"code":"8500418","type":"CDM"},{"code":"99235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":486,"gross_charge":608,"discounted_cash":608,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486}]}]},{"description":"Each Multiplex Antibody Stain Procedure","code_information":[{"code":"4000136","type":"CDM"},{"code":"310","type":"RC"},{"code":"88344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":486,"gross_charge":608,"discounted_cash":608,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486}]}]},{"description":"Immunohistochemistry Including Tissue","code_information":[{"code":"4000193","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":486,"gross_charge":608,"discounted_cash":608,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486}]}]},{"description":"Immunohistochemistry/immonocytochemistry","code_information":[{"code":"4000194","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":486,"gross_charge":608,"discounted_cash":608,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486}]}]},{"description":"Tocopherol Alpha Vitamin E","code_information":[{"code":"4000367","type":"CDM"},{"code":"300","type":"RC"},{"code":"84446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":486,"gross_charge":608,"discounted_cash":608,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486}]}]},{"description":"Hla Class Ii Typing Low Resolution Eg","code_information":[{"code":"4000183","type":"CDM"},{"code":"300","type":"RC"},{"code":"81375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":485,"maximum":485,"gross_charge":606,"discounted_cash":606,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":485}]}]},{"description":"Hla Dr/dq","code_information":[{"code":"8400486","type":"CDM"},{"code":"300","type":"RC"},{"code":"81375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":485,"maximum":485,"gross_charge":606,"discounted_cash":606,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":485}]}]},{"description":"Trim Skin Lesion","code_information":[{"code":"1000192","type":"CDM"},{"code":"450","type":"RC"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":485,"maximum":924,"gross_charge":606,"discounted_cash":606,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":485}]}]},{"description":"2.4mm Cortex Screw, Self Tapping 14mm","code_information":[{"code":"2800005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":484,"gross_charge":605,"discounted_cash":605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":484}]}]},{"description":"Synthes 2.4 Cortex Screw 12mm","code_information":[{"code":"2800571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":484,"gross_charge":605,"discounted_cash":605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":484}]}]},{"description":"Synthes 2.4mm Cortex Screw Self Tapping","code_information":[{"code":"2800573","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":484,"gross_charge":605,"discounted_cash":605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":484}]}]},{"description":"Synthes 2.4mm Cortex Screw Self-tapping","code_information":[{"code":"2800574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":484,"gross_charge":605,"discounted_cash":605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":484}]}]},{"description":"Synthes 2.4mm Cortex Self Tapping Screw","code_information":[{"code":"2800575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":484,"gross_charge":605,"discounted_cash":605,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":484}]}]},{"description":"X Ray Ankle 2 Views","code_information":[{"code":"8401505","type":"CDM"},{"code":"359","type":"RC"},{"code":"73600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":482,"maximum":482,"gross_charge":602,"discounted_cash":602,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":482}]}]},{"description":"Methocarbamol (Robaxn) 1000mg/10ml","code_information":[{"code":"3000189","type":"CDM"},{"code":"636","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":482,"maximum":482,"gross_charge":602,"discounted_cash":602,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":482}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Splint Wristhand Orthosis","code_information":[{"code":"8401340","type":"CDM"},{"code":"450","type":"RC"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":481,"maximum":481,"gross_charge":601,"discounted_cash":601,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":481}]}]},{"description":"N Block Inj Occipital","code_information":[{"code":"8500322","type":"CDM"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":481,"maximum":924,"gross_charge":601,"discounted_cash":601,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":481}]}]},{"description":"N Block Inj Pudendal","code_information":[{"code":"8500327","type":"CDM"},{"code":"64430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":481,"maximum":924,"gross_charge":601,"discounted_cash":601,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":481}]}]},{"description":"Anitbody Sars Coronavisrus 2","code_information":[{"code":"4000015","type":"CDM"},{"code":"300","type":"RC"},{"code":"86769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":481,"maximum":481,"gross_charge":601,"discounted_cash":601,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":481}]}]},{"description":"Sars Covid Antibody Test","code_information":[{"code":"8400688","type":"CDM"},{"code":"300","type":"RC"},{"code":"86769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":481,"maximum":481,"gross_charge":601,"discounted_cash":601,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":481}]}]},{"description":"Xr Knee Both Knees Standing Anteropst","code_information":[{"code":"8401502","type":"CDM"},{"code":"329","type":"RC"},{"code":"73565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":481,"maximum":481,"gross_charge":601,"discounted_cash":601,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":481}]}]},{"description":"Life Spine Locking Cap","code_information":[{"code":"2800268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":480,"maximum":480,"gross_charge":600,"discounted_cash":600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":480}]}]},{"description":"Endoscope, Single-use (I.e. Disposable),","code_information":[{"code":"2810108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":480,"maximum":480,"gross_charge":600,"discounted_cash":600,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":480}]}]},{"description":"Repair Complex Trunk Each Add 5 Cm/<","code_information":[{"code":"8400121","type":"CDM"},{"code":"450","type":"RC"},{"code":"13102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":480,"maximum":924,"gross_charge":600,"discounted_cash":600,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":480}]}]},{"description":"Clsd Tx Metacarpal Fract Single Wo/manip","code_information":[{"code":"8500195","type":"CDM"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":477,"maximum":477,"gross_charge":596,"discounted_cash":596,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":477}]}]},{"description":"Synthes 1.5 Cortex Screw 8mm","code_information":[{"code":"2800561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":476,"maximum":476,"gross_charge":595,"discounted_cash":595,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":476}]}]},{"description":"Synthes 1.5 Cortex Screw 9mm","code_information":[{"code":"2800562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":476,"maximum":476,"gross_charge":595,"discounted_cash":595,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":476}]}]},{"description":"Synthes 1.5mm Cortex Screw Slf-tpng With","code_information":[{"code":"2800566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":476,"maximum":476,"gross_charge":595,"discounted_cash":595,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":476}]}]},{"description":"Potassium Chloride 20meq/15ml Oral Sol","code_information":[{"code":"3060799","type":"CDM"},{"code":"636","type":"RC"},{"code":"12116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":476,"maximum":476,"gross_charge":595,"discounted_cash":595,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":476}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Cetacaine Spray 20gm Bottle","code_information":[{"code":"3060844","type":"CDM"},{"code":"250","type":"RC"},{"code":"10223020103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":475,"maximum":475,"gross_charge":594,"discounted_cash":594,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":475}]}],"drug_information":{"unit":20,"type":"GR"}},{"description":"Debride Skin At Fx Site","code_information":[{"code":"8500077","type":"CDM"},{"code":"11010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":474,"maximum":1058,"gross_charge":593,"discounted_cash":593,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":474}]}]},{"description":"X Ray Wrist 2 Views","code_information":[{"code":"8401483","type":"CDM"},{"code":"359","type":"RC"},{"code":"73100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":471,"maximum":471,"gross_charge":589,"discounted_cash":589,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":471}]}]},{"description":"Rmvl Fb Xtrnl Eye Crnl W/slit Lamp","code_information":[{"code":"8400337","type":"CDM"},{"code":"450","type":"RC"},{"code":"65222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":470,"maximum":470,"gross_charge":588,"discounted_cash":588,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":470}]}]},{"description":"Cbt 1st Hour","code_information":[{"code":"6400002","type":"CDM"},{"code":"410","type":"RC"},{"code":"94644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":470,"gross_charge":588,"discounted_cash":588,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Pulmonary Testing Spirometry","code_information":[{"code":"64000006","type":"CDM"},{"code":"410","type":"RC"},{"code":"94060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":470,"gross_charge":588,"discounted_cash":588,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Respiratory Virus Panel 1","code_information":[{"code":"8400768","type":"CDM"},{"code":"300","type":"RC"},{"code":"87632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":469,"maximum":469,"gross_charge":586,"discounted_cash":586,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":469}]}]},{"description":"Incision&removal Fb Subq Tiss Smpl","code_information":[{"code":"8400072","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":468,"maximum":924,"gross_charge":585,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Puncture Asp Abscess Hematoma Bulla/cyst","code_information":[{"code":"8400075","type":"CDM"},{"code":"450","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":468,"maximum":924,"gross_charge":585,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Debrdmnt Subq Tissue 1st 20 Sq Cm/<","code_information":[{"code":"8400079","type":"CDM"},{"code":"450","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":468,"maximum":1058,"gross_charge":585,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Excision Benign Lesion Trunk Arms O","code_information":[{"code":"8400085","type":"CDM"},{"code":"360","type":"RC"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":468,"maximum":924,"gross_charge":585,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Stryker Bone Screw T10 Full Thread 3.5mm","code_information":[{"code":"2800472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":468,"maximum":468,"gross_charge":585,"discounted_cash":585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Depuy Synthes 2.0 Cortex Screw 10mm","code_information":[{"code":"2800175","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":468,"maximum":468,"gross_charge":585,"discounted_cash":585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Depuy Synthes 2.0 Cortex Screw 9","code_information":[{"code":"2800176","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":468,"maximum":468,"gross_charge":585,"discounted_cash":585,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Inf Agent Det Hepatitis C Quantification","code_information":[{"code":"4000230","type":"CDM"},{"code":"300","type":"RC"},{"code":"87522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":467,"maximum":467,"gross_charge":584,"discounted_cash":584,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467}]}]},{"description":"Tracheotomy Tube Change","code_information":[{"code":"8500262","type":"CDM"},{"code":"31502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":467,"maximum":924,"gross_charge":584,"discounted_cash":584,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467}]}]},{"description":"Natriuretic Peptide","code_information":[{"code":"4000273","type":"CDM"},{"code":"300","type":"RC"},{"code":"83880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":466,"maximum":466,"gross_charge":583,"discounted_cash":583,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":466}]}]},{"description":"Xr Stress View","code_information":[{"code":"5000109","type":"CDM"},{"code":"320","type":"RC"},{"code":"77071","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":465,"maximum":465,"gross_charge":581,"discounted_cash":581,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":465}]}]},{"description":"Iv Infusion Other","code_information":[{"code":"3100007","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":463,"gross_charge":579,"discounted_cash":579,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"X Ray Sacroiliac Joints 3 Or More Views","code_information":[{"code":"8401468","type":"CDM"},{"code":"359","type":"RC"},{"code":"72202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":463,"maximum":463,"gross_charge":579,"discounted_cash":579,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":463}]}]},{"description":"Inf Agent Det Dna/rna Multiple Organisms","code_information":[{"code":"4000218","type":"CDM"},{"code":"300","type":"RC"},{"code":"87800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":463,"maximum":463,"gross_charge":579,"discounted_cash":579,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":463}]}]},{"description":"Synthes Screw 2.4 Locking 16mm","code_information":[{"code":"2800643","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":461,"maximum":461,"gross_charge":576,"discounted_cash":576,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":461}]}]},{"description":"Xr Tmj Open And Closed Mouth Unilat","code_information":[{"code":"8401437","type":"CDM"},{"code":"359","type":"RC"},{"code":"70328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":461,"maximum":461,"gross_charge":576,"discounted_cash":576,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":461}]}]},{"description":"Moderate Sedation Services","code_information":[{"code":"8400405","type":"CDM"},{"code":"370","type":"RC"},{"code":"99151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":461,"maximum":461,"gross_charge":576,"discounted_cash":576,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":461}]}]},{"description":"X Ray Finger(s) Minimum Of 2 Views","code_information":[{"code":"8401488","type":"CDM"},{"code":"359","type":"RC"},{"code":"73140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":458,"maximum":458,"gross_charge":572,"discounted_cash":572,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":458}]}]},{"description":"Xr Chest 2 Vw W/oblique Proj","code_information":[{"code":"8401443","type":"CDM"},{"code":"359","type":"RC"},{"code":"71022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":458,"maximum":458,"gross_charge":572,"discounted_cash":572,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":458}]}]},{"description":"Cine/video Xrs Add-on","code_information":[{"code":"5000041","type":"CDM"},{"code":"320","type":"RC"},{"code":"76125","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":457,"maximum":457,"gross_charge":571,"discounted_cash":571,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":457},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":457},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":457}]}]},{"description":"Synthes Screw 811.96","code_information":[{"code":"2800645","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":456,"maximum":456,"gross_charge":570,"discounted_cash":570,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":456}]}]},{"description":"Moderate Sedation Same Phys Qhp > 5 Yrs","code_information":[{"code":"8400406","type":"CDM"},{"code":"370","type":"RC"},{"code":"99152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":455,"maximum":455,"gross_charge":569,"discounted_cash":569,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":455}]}]},{"description":"Culture Fungi Mold Or Yeast","code_information":[{"code":"4000116","type":"CDM"},{"code":"300","type":"RC"},{"code":"87102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":455,"maximum":455,"gross_charge":569,"discounted_cash":569,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":455}]}]},{"description":"Preputial Stretching","code_information":[{"code":"8400308","type":"CDM"},{"code":"450","type":"RC"},{"code":"54450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":454,"maximum":924,"gross_charge":568,"discounted_cash":568,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":454}]}]},{"description":"Immunoassay For Infectious Agent","code_information":[{"code":"4000186","type":"CDM"},{"code":"300","type":"RC"},{"code":"86328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":452,"maximum":452,"gross_charge":565,"discounted_cash":565,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":452}]}]},{"description":"Immunodiffusion Not Elsewhere Specified","code_information":[{"code":"4000191","type":"CDM"},{"code":"300","type":"RC"},{"code":"86329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":452,"maximum":452,"gross_charge":565,"discounted_cash":565,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":452}]}]},{"description":"Immunoassay Infecti Agent Covid 19 Sars","code_information":[{"code":"8400641","type":"CDM"},{"code":"300","type":"RC"},{"code":"86328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":452,"maximum":452,"gross_charge":565,"discounted_cash":565,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":452}]}]},{"description":"Smpl Repair S/n/s/g/t 2.6cm To 7.5cm","code_information":[{"code":"8400096","type":"CDM"},{"code":"450","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":452,"maximum":452,"gross_charge":565,"discounted_cash":565,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":452}]}]},{"description":"Repair Intermediate S/a/t/e 12.6-20.0cm","code_information":[{"code":"8500110","type":"CDM"},{"code":"12035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":451,"maximum":1058,"gross_charge":564,"discounted_cash":564,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":451}]}]},{"description":"Intmd Rpr N-hf/genit12.6-20","code_information":[{"code":"8500114","type":"CDM"},{"code":"12045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":1058,"gross_charge":562,"discounted_cash":562,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450}]}]},{"description":"Clsd Tx Distal Phalangeal Fract W/manip","code_information":[{"code":"8500205","type":"CDM"},{"code":"26755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":450,"gross_charge":562,"discounted_cash":562,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450}]}]},{"description":"Synthes Tension Wire Large","code_information":[{"code":"2800647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":448,"maximum":448,"gross_charge":560,"discounted_cash":560,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":448},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":448},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":448}]}]},{"description":"Initial new patient preventative medicine evaluation (18-39 years)","code_information":[{"code":"8400428","type":"CDM"},{"code":"521","type":"RC"},{"code":"99385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":447,"maximum":447,"gross_charge":559,"discounted_cash":559,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":447}]}]},{"description":"Initial new patient preventative medicine evaluation (18-39 years)","code_information":[{"code":"8500428","type":"CDM"},{"code":"521","type":"RC"},{"code":"99385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":447,"maximum":447,"gross_charge":559,"discounted_cash":559,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":447}]}]},{"description":"Thrombolytic Therapy Stroke","code_information":[{"code":"8400279","type":"CDM"},{"code":"450","type":"RC"},{"code":"37195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":447,"maximum":447,"gross_charge":559,"discounted_cash":559,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":447}]}]},{"description":"Ecg Routine With 12 Leads Tracing Only","code_information":[{"code":"4200007","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":446,"gross_charge":558,"discounted_cash":558,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Ecg/12 Leads Interpretation And Rpt Only","code_information":[{"code":"4200008","type":"CDM"},{"code":"730","type":"RC"},{"code":"93010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":446,"gross_charge":558,"discounted_cash":558,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"N Block Inj Cervical Plexus","code_information":[{"code":"8500323","type":"CDM"},{"code":"64413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":446,"maximum":446,"gross_charge":558,"discounted_cash":558,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":446}]}]},{"description":"N Block Inj Cervical Plexus","code_information":[{"code":"8543230","type":"CDM"},{"code":"64999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":446,"maximum":924,"gross_charge":558,"discounted_cash":558,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":446}]}]},{"description":"Simple Repair S/n/s/g/t 2.5cm Or Less","code_information":[{"code":"8400095","type":"CDM"},{"code":"360","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":446,"maximum":924,"gross_charge":557,"discounted_cash":557,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":446}]}]},{"description":"Simple Repair F/e/e/n/l/m 7.6cm-12.5cm","code_information":[{"code":"8500103","type":"CDM"},{"code":"12015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":446,"maximum":924,"gross_charge":557,"discounted_cash":557,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":446}]}]},{"description":"Arterial Puncture W/drawal Blood For Dx","code_information":[{"code":"2200103","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442,"maximum":442,"gross_charge":553,"discounted_cash":553,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":442}]}]},{"description":"N-invas Physio Std Xtrc Art Compl Bi Std","code_information":[{"code":"8500374","type":"CDM"},{"code":"93875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":441,"maximum":441,"gross_charge":551,"discounted_cash":551,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":441}]}]},{"description":"Clsd Tx Metatarsal Fract Wo Manip Each","code_information":[{"code":"8500230","type":"CDM"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":441,"maximum":924,"gross_charge":551,"discounted_cash":551,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":441}]}]},{"description":"X Ray Eye For Detection Of Foreign Body","code_information":[{"code":"8401425","type":"CDM"},{"code":"450","type":"RC"},{"code":"70030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":441,"maximum":441,"gross_charge":551,"discounted_cash":551,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":441}]}]},{"description":"Clsd Tx Scapular Fracture W/o Manip","code_information":[{"code":"8500163","type":"CDM"},{"code":"23570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":440,"maximum":924,"gross_charge":550,"discounted_cash":550,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":440}]}]},{"description":"Repair Complex Trunk 1.1 Cm To 2.5 Cm","code_information":[{"code":"8500119","type":"CDM"},{"code":"13100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":440,"maximum":1058,"gross_charge":550,"discounted_cash":550,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":440}]}]},{"description":"Corelink 3.5x14mm Fixed Screw","code_information":[{"code":"2800137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":440,"maximum":440,"gross_charge":550,"discounted_cash":550,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":440}]}]},{"description":"Corelink 4.0x 14mm Fixed Screw","code_information":[{"code":"2800138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":440,"maximum":440,"gross_charge":550,"discounted_cash":550,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":440}]}]},{"description":"Xr Sinuses Paranasal Less Than 3 Vw","code_information":[{"code":"8401433","type":"CDM"},{"code":"359","type":"RC"},{"code":"70210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":440,"maximum":440,"gross_charge":550,"discounted_cash":550,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":440}]}]},{"description":"Stryker 1.7 X5 Cortex Screw","code_information":[{"code":"2800422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":437,"maximum":437,"gross_charge":546,"discounted_cash":546,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":437}]}]},{"description":"Stryker 1.7 X8 Non-locking Screw","code_information":[{"code":"2800424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":437,"maximum":437,"gross_charge":546,"discounted_cash":546,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":437}]}]},{"description":"X Ray Neck Soft Tissue","code_information":[{"code":"8401439","type":"CDM"},{"code":"329","type":"RC"},{"code":"70360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":435,"maximum":435,"gross_charge":544,"discounted_cash":544,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":435}]}]},{"description":"Clean Out Mastoid Cavity","code_information":[{"code":"1000085","type":"CDM"},{"code":"450","type":"RC"},{"code":"69220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":434,"maximum":434,"gross_charge":543,"discounted_cash":543,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434}]}]},{"description":"Dbrdmt Mstdc Cavity Smpl","code_information":[{"code":"8400348","type":"CDM"},{"code":"450","type":"RC"},{"code":"69220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":434,"maximum":434,"gross_charge":543,"discounted_cash":543,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434}]}]},{"description":"Removal Foreign Body Gum","code_information":[{"code":"8500289","type":"CDM"},{"code":"41805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":924,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433}]}]},{"description":"Drainage Of Mouth Lesion","code_information":[{"code":"8500283","type":"CDM"},{"code":"40800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":433,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433}]}]},{"description":"Stryke Locking Screw T6 2.0mm L12mm","code_information":[{"code":"2800417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":432,"maximum":432,"gross_charge":540,"discounted_cash":540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Stryker Locking Screw Full Thread 2.4/12","code_information":[{"code":"2800513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":432,"maximum":432,"gross_charge":540,"discounted_cash":540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Stryker Locking Screw Full Thread 2.4/14","code_information":[{"code":"2800514","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":432,"maximum":432,"gross_charge":540,"discounted_cash":540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Stryker Locking Screw Full Thread 2.4/20","code_information":[{"code":"2800516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":432,"maximum":432,"gross_charge":540,"discounted_cash":540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Stryker Locking Screw Full Thread 2.7mm","code_information":[{"code":"2800517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":432,"maximum":432,"gross_charge":540,"discounted_cash":540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Stryker Locking Screw Full Thread 2.4/16","code_information":[{"code":"2800515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":432,"maximum":432,"gross_charge":540,"discounted_cash":540,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Repair Tongue Laceration 1/3 Of Tongue","code_information":[{"code":"8400286","type":"CDM"},{"code":"450","type":"RC"},{"code":"41251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":430,"maximum":1058,"gross_charge":537,"discounted_cash":537,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"Rmvl Impacted Cerumen Spx 1/bth Ears","code_information":[{"code":"8400347","type":"CDM"},{"code":"450","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":429,"maximum":924,"gross_charge":536,"discounted_cash":536,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":429}]}]},{"description":"Hemoperfusion","code_information":[{"code":"8400353","type":"CDM"},{"code":"450","type":"RC"},{"code":"90997","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":429,"maximum":429,"gross_charge":536,"discounted_cash":536,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":429}]}]},{"description":"Xr Spine Entire Th Lum 4 Views","code_information":[{"code":"5000332","type":"CDM"},{"code":"320","type":"RC"},{"code":"72083","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":427,"maximum":427,"gross_charge":534,"discounted_cash":534,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":427}]}]},{"description":"Stryker 5 Hole T Plate","code_information":[{"code":"2800443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":427,"maximum":427,"gross_charge":534,"discounted_cash":534,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":427}]}]},{"description":"Closed Tx Clavicular Fracture W/o Manip","code_information":[{"code":"8500161","type":"CDM"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":426,"maximum":924,"gross_charge":533,"discounted_cash":533,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":426}]}]},{"description":"I&d Absc Pritonsillar","code_information":[{"code":"8400290","type":"CDM"},{"code":"450","type":"RC"},{"code":"42700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":425,"maximum":924,"gross_charge":531,"discounted_cash":531,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":425}]}]},{"description":"Repair Complex Trunk 2.6 Cm To 7.5 Cm","code_information":[{"code":"8500120","type":"CDM"},{"code":"13101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":425,"maximum":1232,"gross_charge":531,"discounted_cash":531,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":425}]}]},{"description":"Place Catheter In Vein","code_information":[{"code":"1000253","type":"CDM"},{"code":"450","type":"RC"},{"code":"36011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":924,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Slctv Cath Plmt Ven Sys 1st Order Branch","code_information":[{"code":"8400273","type":"CDM"},{"code":"450","type":"RC"},{"code":"36011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":924,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Removal Of Foreign Body From Pharynx","code_information":[{"code":"8400291","type":"CDM"},{"code":"450","type":"RC"},{"code":"42809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":924,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Naso/oro-gas Tube Plmt Req Phys&fluor Gd","code_information":[{"code":"8400292","type":"CDM"},{"code":"450","type":"RC"},{"code":"43752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":1058,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"8400335","type":"CDM"},{"code":"450","type":"RC"},{"code":"65210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":422,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Rmvl Fb Xtrnl Eye Crnl W/o Slit Lamp","code_information":[{"code":"8400336","type":"CDM"},{"code":"450","type":"RC"},{"code":"65220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":422,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Fluorescein Angioscopy W/int&rep","code_information":[{"code":"8400357","type":"CDM"},{"code":"450","type":"RC"},{"code":"92230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":422,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Or Level 7 Each Add'l Min","code_information":[{"code":"2202995","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202995","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":421,"maximum":421,"gross_charge":526,"discounted_cash":526,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":421}]}]},{"description":"App Surface Transcutaneous Neurostim","code_information":[{"code":"1000120","type":"CDM"},{"code":"450","type":"RC"},{"code":"64550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":420,"maximum":420,"gross_charge":525,"discounted_cash":525,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":420}]}]},{"description":"Apply Neurostimulator","code_information":[{"code":"8400332","type":"CDM"},{"code":"450","type":"RC"},{"code":"64550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":420,"maximum":420,"gross_charge":525,"discounted_cash":525,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":420}]}]},{"description":"Apply Neurostimulator","code_information":[{"code":"8500332","type":"CDM"},{"code":"64550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":420,"maximum":420,"gross_charge":525,"discounted_cash":525,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":420}]}]},{"description":"Electrocardiogram, routine, with interpretation and report","code_information":[{"code":"CP17428476722282039","type":"CDM"},{"code":"730","type":"RC"},{"code":"93000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":420,"gross_charge":525,"discounted_cash":525,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Clsd Tx Ip Joint Disloc Sng W/manp Wo/an","code_information":[{"code":"8500206","type":"CDM"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":419,"maximum":419,"gross_charge":524,"discounted_cash":524,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":419}]}]},{"description":"Synovial/csf Fluid","code_information":[{"code":"4000329","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":419,"maximum":419,"gross_charge":524,"discounted_cash":524,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":419}]}]},{"description":"Rep Cmp F/c/c/m/n/ax/g/h/f 1.1 Cm-2.5 Cm","code_information":[{"code":"8500125","type":"CDM"},{"code":"13131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":419,"maximum":1058,"gross_charge":524,"discounted_cash":524,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":419}]}]},{"description":"Application Finger Splint Static","code_information":[{"code":"1000109","type":"CDM"},{"code":"450","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":418,"gross_charge":523,"discounted_cash":523,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Incision Of Thrombosed Hemorrhoid Extrnl","code_information":[{"code":"8500298","type":"CDM"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":418,"maximum":924,"gross_charge":522,"discounted_cash":522,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":418}]}]},{"description":"Emer Dept Self Limited/minor","code_information":[{"code":"8400420","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":416,"maximum":416,"gross_charge":520,"discounted_cash":520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":416}]}]},{"description":"Geminus Screw Cortical Locking 3.5mm X12","code_information":[{"code":"2800215","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":416,"maximum":416,"gross_charge":520,"discounted_cash":520,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":416}]}]},{"description":"Laryngoscopy With Foreign Body Removal","code_information":[{"code":"8500264","type":"CDM"},{"code":"31530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":414,"maximum":1058,"gross_charge":518,"discounted_cash":518,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":414}]}]},{"description":"Strapping Toes","code_information":[{"code":"1000272","type":"CDM"},{"code":"450","type":"RC"},{"code":"29550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":412,"maximum":412,"gross_charge":515,"discounted_cash":515,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":412}]}]},{"description":"Stryker Prolayer Dermal Matrix  4x8 Per","code_information":[{"code":"2800541","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":412,"maximum":412,"gross_charge":515,"discounted_cash":515,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":412}]}]},{"description":"Us Arterial Upper Ext Bilat","code_information":[{"code":"5100012","type":"CDM"},{"code":"402","type":"RC"},{"code":"93930","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":410,"maximum":410,"gross_charge":512,"discounted_cash":512,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":410}]}]},{"description":"Us Dup Scn Up Ext Art/artl Bpgs Blt/cmp","code_information":[{"code":"8401405","type":"CDM"},{"code":"921","type":"RC"},{"code":"93930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":1060,"gross_charge":512,"discounted_cash":512,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Arthrosurface Disposable Pin","code_information":[{"code":"2800100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":408,"maximum":408,"gross_charge":510,"discounted_cash":510,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":408}]}]},{"description":"J&j 2.0mm Cortex Screw Slf Tapping","code_information":[{"code":"2802674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":408,"maximum":408,"gross_charge":510,"discounted_cash":510,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":408}]}]},{"description":"J&j 2.0mm Ti Cortex Screw 6mm","code_information":[{"code":"2802675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":408,"maximum":408,"gross_charge":510,"discounted_cash":510,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":408}]}]},{"description":"J&j 2.0mm Ti Cortex Screw 10mm","code_information":[{"code":"2802676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":408,"maximum":408,"gross_charge":510,"discounted_cash":510,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":408}]}]},{"description":"N Block Inj Brachial Plexus","code_information":[{"code":"8500324","type":"CDM"},{"code":"64415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":408,"maximum":924,"gross_charge":510,"discounted_cash":510,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":408}]}]},{"description":"Dantrium Iv 20mg","code_information":[{"code":"3000063","type":"CDM"},{"code":"636","type":"RC"},{"code":"42023012306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":408,"maximum":408,"gross_charge":510,"discounted_cash":510,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":408}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Insj Temp Ndwellg Bldr Cath Comp","code_information":[{"code":"8400305","type":"CDM"},{"code":"450","type":"RC"},{"code":"51703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":924,"gross_charge":508,"discounted_cash":508,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"Ankle Control Orthosi Prefab","code_information":[{"code":"8401344","type":"CDM"},{"code":"450","type":"RC"},{"code":"L4350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":406,"gross_charge":508,"discounted_cash":508,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"Non-pneum Walk Boot Pre Ots","code_information":[{"code":"8401346","type":"CDM"},{"code":"450","type":"RC"},{"code":"L4387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":406,"gross_charge":508,"discounted_cash":508,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"Blepharotomy Drg Absc Eyelid","code_information":[{"code":"8500340","type":"CDM"},{"code":"67700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":924,"gross_charge":507,"discounted_cash":507,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"Stryker 3.5mmx22mm Screw","code_information":[{"code":"2800438","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Stryker 3.5mmx24mm Screw","code_information":[{"code":"2800439","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Stryker Anchor Standard Screw 3mm X 16mm","code_information":[{"code":"2800456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Stryker Anchor Standard Screw 3mm X12mm","code_information":[{"code":"2800457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Stryker Anchor Standard Screw 3mmx14mm","code_information":[{"code":"2800458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Stryker Anchor Standard Screw 3x24mm","code_information":[{"code":"2800459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Stryker Anchor Standard Screw 3x26mm","code_information":[{"code":"2800460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Stryker Anchorage Screw 3mm X30mm","code_information":[{"code":"2800465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Stryker Anchorage Standard Screw 3.5mmx2","code_information":[{"code":"2800466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":405,"maximum":405,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Inf Agent Hiv1 Rev Qualitative","code_information":[{"code":"4000247","type":"CDM"},{"code":"300","type":"RC"},{"code":"86701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":402,"gross_charge":503,"discounted_cash":503,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Inf Agent Hiv1 Genotype","code_information":[{"code":"4000248","type":"CDM"},{"code":"300","type":"RC"},{"code":"87901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":402,"gross_charge":503,"discounted_cash":503,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Hiv-1 Rna Qnt Tr-pcr Rflx To Phenosnc Gt","code_information":[{"code":"8400784","type":"CDM"},{"code":"300","type":"RC"},{"code":"87901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":402,"gross_charge":503,"discounted_cash":503,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Drg Xtrnl Ear Absc/hmtma Comp","code_information":[{"code":"8500343","type":"CDM"},{"code":"69005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":924,"gross_charge":503,"discounted_cash":503,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Stryker Ex Clip 3mm Positioning Pin","code_information":[{"code":"2800492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":402,"gross_charge":503,"discounted_cash":503,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Gases Blood","code_information":[{"code":"4000155","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":402,"gross_charge":502,"discounted_cash":502,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Gases Bld Ph Calculated O2 Saturation","code_information":[{"code":"8400533","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":402,"gross_charge":502,"discounted_cash":502,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Parietene Macroporous Mesh 11cm X 6 Cm","code_information":[{"code":"2800345","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":401,"maximum":401,"gross_charge":501,"discounted_cash":501,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":401}]}]},{"description":"In2bones Afx ;Pw [Rp Cprtoca; Screw 3.5x","code_information":[{"code":"2800231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":400,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"Monet Screw Va 3.5x16","code_information":[{"code":"2800323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":400,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"Spinal Element Set Screws","code_information":[{"code":"2800370","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":400,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"Spine Elements Kwires","code_information":[{"code":"2800406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":400,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"Tl Amedica Monet Screw Fa Self Drilling","code_information":[{"code":"2800670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":400,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"Agen Fx Pin","code_information":[{"code":"28007578","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":400,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"Rep Cmp F/c/c/m/n/ax/g/h/f Ea 5 Cm/<","code_information":[{"code":"8500127","type":"CDM"},{"code":"13133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":924,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"Repair Inter N/h/f/xtrnl Gent 7.6-12.5cm","code_information":[{"code":"8500113","type":"CDM"},{"code":"12044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":1058,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"Repair Inter N/h/f/xtrnl Gent 2.6-7.5 Cm","code_information":[{"code":"8500112","type":"CDM"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":399,"maximum":924,"gross_charge":499,"discounted_cash":499,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Er Visit Level 1","code_information":[{"code":"1000288","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":399,"maximum":399,"gross_charge":499,"discounted_cash":499,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Rem Fb Of Ear Xtrnl Aud Canal W/o Anes","code_information":[{"code":"8400344","type":"CDM"},{"code":"450","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":399,"maximum":399,"gross_charge":499,"discounted_cash":499,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Xr Hips Unilateral W/pelvis 1 View","code_information":[{"code":"8401489","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":398,"maximum":398,"gross_charge":498,"discounted_cash":498,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":398}]}]},{"description":"Simple Repair F E E N L M 2.5cm Or Less","code_information":[{"code":"8500100","type":"CDM"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":398,"maximum":398,"gross_charge":497,"discounted_cash":497,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":398}]}]},{"description":"Simple Repair F/e/e/n/l/m 2.6cm-5.0cm","code_information":[{"code":"8500101","type":"CDM"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":398,"maximum":398,"gross_charge":497,"discounted_cash":497,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":398}]}]},{"description":"Incision&drain Abscess Simple Single","code_information":[{"code":"8500068","type":"CDM"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":398,"maximum":924,"gross_charge":497,"discounted_cash":497,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":398}]}]},{"description":"Tb Skin Test 0.1ml Tuberculin","code_information":[{"code":"3000295","type":"CDM"},{"code":"250","type":"RC"},{"code":"4928175221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":398,"maximum":398,"gross_charge":497,"discounted_cash":497,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":398}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Gentamicin","code_information":[{"code":"4000159","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":396,"maximum":396,"gross_charge":495,"discounted_cash":495,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":396}]}]},{"description":"Change Of Gastromy Tube","code_information":[{"code":"8400294","type":"CDM"},{"code":"450","type":"RC"},{"code":"43760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":394,"maximum":394,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":394}]}]},{"description":"Initial Observation Care Modcomplex","code_information":[{"code":"8500415","type":"CDM"},{"code":"99219","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391,"maximum":391,"gross_charge":489,"discounted_cash":489,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":391}]}]},{"description":"Removal Foreign Body Foot Subcutaneous","code_information":[{"code":"8500225","type":"CDM"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":390,"maximum":1058,"gross_charge":488,"discounted_cash":488,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":390}]}]},{"description":"Incision & Drainage Of Scrotal Abscess","code_information":[{"code":"8500309","type":"CDM"},{"code":"54700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":386,"maximum":1058,"gross_charge":483,"discounted_cash":483,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":386}]}]},{"description":"Pathology Consultation During Surgery","code_information":[{"code":"4000307","type":"CDM"},{"code":"310","type":"RC"},{"code":"88329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":386,"maximum":386,"gross_charge":483,"discounted_cash":483,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":386}]}]},{"description":"Estradiol","code_information":[{"code":"4000140","type":"CDM"},{"code":"300","type":"RC"},{"code":"82670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":384,"maximum":384,"gross_charge":480,"discounted_cash":480,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":384}]}]},{"description":"Observation Care Same Day Low Complexity","code_information":[{"code":"8500417","type":"CDM"},{"code":"99234","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":384,"maximum":384,"gross_charge":480,"discounted_cash":480,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":384}]}]},{"description":"Simple Repair F/e/e/n/l/m 5.1cm-7.5cm","code_information":[{"code":"8500102","type":"CDM"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":924,"gross_charge":478,"discounted_cash":478,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382}]}]},{"description":"X Ray Mandible Partial Less Than 4 Views","code_information":[{"code":"8401426","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":382,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382}]}]},{"description":"Pulmonary Test Spirom","code_information":[{"code":"6400007","type":"CDM"},{"code":"410","type":"RC"},{"code":"94060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":382,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Sugammadex 100mg/ml 2ml Vial","code_information":[{"code":"3000290","type":"CDM"},{"code":"636","type":"RC"},{"code":"65423","type":"CPT","modifier":"12"}],"standard_charges":[{"setting":"outpatient","modifier_code":["12"],"minimum":382,"maximum":382,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Iv Therapy 1st 1 Hour","code_information":[{"code":"8400384","type":"CDM"},{"code":"450","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":381,"gross_charge":476,"discounted_cash":476,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Synthes 2.7 X 16mm Cortex Screw","code_information":[{"code":"2800582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":380,"maximum":380,"gross_charge":475,"discounted_cash":475,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":380}]}]},{"description":"Insj Temp Ndwellg Bldr Cath Smpl","code_information":[{"code":"8400304","type":"CDM"},{"code":"450","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":378,"maximum":924,"gross_charge":473,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":378}]}]},{"description":"Clsd Tx Calcaneal Fract Wo Manip","code_information":[{"code":"8500228","type":"CDM"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":376,"maximum":924,"gross_charge":470,"discounted_cash":470,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":376}]}]},{"description":"Calcifediol 25-oh Vitamin D3","code_information":[{"code":"4000080","type":"CDM"},{"code":"300","type":"RC"},{"code":"82306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":374,"maximum":374,"gross_charge":467,"discounted_cash":467,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":374}]}]},{"description":"Us Extremity Nonvasc Rt W/img Doc Limit","code_information":[{"code":"8401397","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":373,"maximum":373,"gross_charge":466,"discounted_cash":466,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":373}]}]},{"description":"Tx Gastro Intub W/asp","code_information":[{"code":"1000140","type":"CDM"},{"code":"450","type":"RC"},{"code":"43753","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":372,"maximum":924,"gross_charge":465,"discounted_cash":465,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372}]}]},{"description":"Pulm Stress Test Complex Incl Co3","code_information":[{"code":"4200014","type":"CDM"},{"code":"410","type":"RC"},{"code":"94621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":372,"gross_charge":465,"discounted_cash":465,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Tx Gastro Intub W Asp","code_information":[{"code":"8400293","type":"CDM"},{"code":"450","type":"RC"},{"code":"43753","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":372,"maximum":924,"gross_charge":465,"discounted_cash":465,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372}]}]},{"description":"Cardiopulm Resuscitation (Cpr)","code_information":[{"code":"8400358","type":"CDM"},{"code":"450","type":"RC"},{"code":"92950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":372,"gross_charge":465,"discounted_cash":465,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Pulm Strs Tstg Cplx","code_information":[{"code":"8400376","type":"CDM"},{"code":"410","type":"RC"},{"code":"94621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":372,"gross_charge":465,"discounted_cash":465,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Tx Gastro Intub W Asp","code_information":[{"code":"8500293","type":"CDM"},{"code":"43753","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":372,"maximum":924,"gross_charge":465,"discounted_cash":465,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372}]}]},{"description":"Repair Inter F/e/e/n/l/m&/muc 2.6-5.0 Cm","code_information":[{"code":"8500116","type":"CDM"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":372,"maximum":924,"gross_charge":465,"discounted_cash":465,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372}]}]},{"description":"Repair Inter S/a/t/e 7.6-12.5 Cm","code_information":[{"code":"8500109","type":"CDM"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":1058,"gross_charge":464,"discounted_cash":464,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":371}]}]},{"description":"Injection Tendon Sheath/ligament","code_information":[{"code":"8400142","type":"CDM"},{"code":"450","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":370,"maximum":924,"gross_charge":462,"discounted_cash":462,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":370}]}]},{"description":"Injection Tendon Origin/insertion","code_information":[{"code":"8400143","type":"CDM"},{"code":"450","type":"RC"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":370,"maximum":924,"gross_charge":462,"discounted_cash":462,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":370}]}]},{"description":"Inj Single/mlt Trigger Point 1/2 Muscles","code_information":[{"code":"8400144","type":"CDM"},{"code":"450","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":370,"maximum":924,"gross_charge":462,"discounted_cash":462,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":370}]}]},{"description":"Inj Trigger Points 3/> Sng/mult Tendon","code_information":[{"code":"8400145","type":"CDM"},{"code":"450","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":370,"maximum":924,"gross_charge":462,"discounted_cash":462,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":370}]}]},{"description":"Pt Therapeutic Act 1 On 1","code_information":[{"code":"6100017","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":368,"gross_charge":460,"discounted_cash":460,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Use Of Dynamic Activities To Improve Fun","code_information":[{"code":"6100037","type":"CDM"},{"code":"424","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":368,"gross_charge":460,"discounted_cash":460,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Use Of Dynamic Activities To Improve Fun","code_information":[{"code":"6100038","type":"CDM"},{"code":"424","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":368,"gross_charge":460,"discounted_cash":460,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Stryker Anchorage Fixation Pin","code_information":[{"code":"2800462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":368,"gross_charge":460,"discounted_cash":460,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":368}]}]},{"description":"Par/cutting Benign Hyperkeratotic Lsn Sg","code_information":[{"code":"8400080","type":"CDM"},{"code":"450","type":"RC"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":924,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Removal Skin Tag Mlt Fibrocutaneous Tag","code_information":[{"code":"8400084","type":"CDM"},{"code":"450","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":924,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Avulsion Nail Plate Partial Comp Simp 1","code_information":[{"code":"8400088","type":"CDM"},{"code":"450","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":924,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Initial Tx 1st Degree Burn Local Tx","code_information":[{"code":"8400132","type":"CDM"},{"code":"450","type":"RC"},{"code":"16000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":367,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq Sm","code_information":[{"code":"8400133","type":"CDM"},{"code":"450","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":924,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq Md","code_information":[{"code":"8400134","type":"CDM"},{"code":"450","type":"RC"},{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":1058,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Destruct Benign Lesion 1-14","code_information":[{"code":"8400136","type":"CDM"},{"code":"450","type":"RC"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":924,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Tacrolimus","code_information":[{"code":"4000356","type":"CDM"},{"code":"300","type":"RC"},{"code":"80197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":367,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Theophylline","code_information":[{"code":"4000359","type":"CDM"},{"code":"300","type":"RC"},{"code":"80198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":367,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Tacrolimus","code_information":[{"code":"8400467","type":"CDM"},{"code":"300","type":"RC"},{"code":"80197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":367,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Assay Of Theophylline","code_information":[{"code":"8400468","type":"CDM"},{"code":"300","type":"RC"},{"code":"80198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":367,"gross_charge":459,"discounted_cash":459,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Initial Comp Preventat Med E&m Age 12-17","code_information":[{"code":"8400427","type":"CDM"},{"code":"450","type":"RC"},{"code":"99384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366,"maximum":366,"gross_charge":457,"discounted_cash":457,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":366}]}]},{"description":"Initial Comp Preventat Med E&m Age 5-11","code_information":[{"code":"8401540","type":"CDM"},{"code":"450","type":"RC"},{"code":"99383","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366,"maximum":366,"gross_charge":457,"discounted_cash":457,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":366}]}]},{"description":"Initial Comp Preventat Med E&m Age 12-17","code_information":[{"code":"8500427","type":"CDM"},{"code":"99384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366,"maximum":366,"gross_charge":457,"discounted_cash":457,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":366}]}]},{"description":"Initial Comp Preventat Med E&m Age 5-11","code_information":[{"code":"8509100","type":"CDM"},{"code":"450","type":"RC"},{"code":"99383","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366,"maximum":366,"gross_charge":457,"discounted_cash":457,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":366}]}]},{"description":"Fetal Nonstress Test","code_information":[{"code":"1000136","type":"CDM"},{"code":"450","type":"RC"},{"code":"59025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366,"maximum":366,"gross_charge":457,"discounted_cash":457,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":366}]}]},{"description":"I&d Of Bartholin`s Gland Absc","code_information":[{"code":"8400312","type":"CDM"},{"code":"450","type":"RC"},{"code":"56420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366,"maximum":924,"gross_charge":457,"discounted_cash":457,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":366}]}]},{"description":"Fetal Non Stress Test","code_information":[{"code":"8400315","type":"CDM"},{"code":"450","type":"RC"},{"code":"59025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366,"maximum":366,"gross_charge":457,"discounted_cash":457,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":366}]}]},{"description":"Aquatic Physical Therapy","code_information":[{"code":"6100047","type":"CDM"},{"code":"424","type":"RC"},{"code":"97113","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":365,"gross_charge":456,"discounted_cash":456,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Aquatic Physical Therapy","code_information":[{"code":"6100048","type":"CDM"},{"code":"424","type":"RC"},{"code":"97113","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":365,"gross_charge":456,"discounted_cash":456,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Inj Anes Agent Sphenopalatine Ganglion","code_information":[{"code":"8500330","type":"CDM"},{"code":"64505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":364,"maximum":924,"gross_charge":455,"discounted_cash":455,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":364}]}]},{"description":"Level Iii Pathology Gross And Micro Exam","code_information":[{"code":"4000287","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":364,"maximum":364,"gross_charge":455,"discounted_cash":455,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":364}]}]},{"description":"Depuy Synthes 2.0mm Cortex Screw Self Ta","code_information":[{"code":"2800178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":360,"maximum":360,"gross_charge":450,"discounted_cash":450,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360}]}]},{"description":"Synthes Dhs/dcs Compression Screw 36mm","code_information":[{"code":"2800627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":360,"maximum":360,"gross_charge":450,"discounted_cash":450,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360}]}]},{"description":"Repair Inter S/a/t/e 22.6 Cm To 7.5 Cm","code_information":[{"code":"8500108","type":"CDM"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":359,"maximum":924,"gross_charge":449,"discounted_cash":449,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":359}]}]},{"description":"Virus Isolation Tiss Culture Inoculation","code_information":[{"code":"4000391","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":358,"maximum":358,"gross_charge":448,"discounted_cash":448,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":358}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"4000328","type":"CDM"},{"code":"301","type":"RC"},{"code":"84153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":358,"maximum":358,"gross_charge":447,"discounted_cash":447,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":358}]}]},{"description":"Repair Tongue Laceration 2.6cm Or Comp","code_information":[{"code":"8500287","type":"CDM"},{"code":"41252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":357,"maximum":1058,"gross_charge":446,"discounted_cash":446,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":357}]}]},{"description":"Fluorescent Noninfectious Agent Antibody","code_information":[{"code":"4000149","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":357,"maximum":357,"gross_charge":446,"discounted_cash":446,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":357}]}]},{"description":"Arthrex Cancellous Screw Low Profile","code_information":[{"code":"2800080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":356,"maximum":356,"gross_charge":445,"discounted_cash":445,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":356}]}]},{"description":"Testosterone Total","code_information":[{"code":"4000358","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":355,"maximum":355,"gross_charge":444,"discounted_cash":444,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":355}]}]},{"description":"Cast Figure Of 8","code_information":[{"code":"8400237","type":"CDM"},{"code":"450","type":"RC"},{"code":"29049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":354,"maximum":354,"gross_charge":442,"discounted_cash":442,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":354}]}]},{"description":"Removal/bivalving Gauntlet Boot/body Cst","code_information":[{"code":"8400254","type":"CDM"},{"code":"450","type":"RC"},{"code":"29700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":354,"maximum":354,"gross_charge":442,"discounted_cash":442,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":354}]}]},{"description":"Removal/revision Of Cast","code_information":[{"code":"8400255","type":"CDM"},{"code":"450","type":"RC"},{"code":"29705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":354,"maximum":354,"gross_charge":442,"discounted_cash":442,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":354}]}]},{"description":"Rep Cmp Eyelid/nose/ear/lip Ea 5 Cm /<","code_information":[{"code":"8500130","type":"CDM"},{"code":"13153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":1232,"gross_charge":439,"discounted_cash":439,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351}]}]},{"description":"Ant Instrument 2-3 Vertebral Seg Add 1","code_information":[{"code":"2200061","type":"CDM"},{"code":"360","type":"RC"},{"code":"22845","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Ant Instrument 4-7 Vertebral Seg Add 1","code_information":[{"code":"2200063","type":"CDM"},{"code":"360","type":"RC"},{"code":"22846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Ant Instrument =>8 Vertebral Seg Add 1","code_information":[{"code":"2200065","type":"CDM"},{"code":"360","type":"RC"},{"code":"22847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Arthrodesis Sacroiliac Joint Add","code_information":[{"code":"2200114","type":"CDM"},{"code":"360","type":"RC"},{"code":"27279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Neck Spine Fusion","code_information":[{"code":"2200118","type":"CDM"},{"code":"360","type":"RC"},{"code":"22554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Arthrodesis Anterior Interbody Techn","code_information":[{"code":"2200120","type":"CDM"},{"code":"360","type":"RC"},{"code":"22585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Lumbar Spine Fusion","code_information":[{"code":"2200122","type":"CDM"},{"code":"360","type":"RC"},{"code":"22558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Thorax Spine Fusion","code_information":[{"code":"2200124","type":"CDM"},{"code":"360","type":"RC"},{"code":"22556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Neck Spine Fuse&remov Bel C2","code_information":[{"code":"2200126","type":"CDM"},{"code":"360","type":"RC"},{"code":"22551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Arthrodesis Anterior Interbody Disc","code_information":[{"code":"2200128","type":"CDM"},{"code":"360","type":"RC"},{"code":"22552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Arthrodesis Combined Posterior Tech","code_information":[{"code":"2200131","type":"CDM"},{"code":"360","type":"RC"},{"code":"22634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Lumbar Spine Fusion Combined","code_information":[{"code":"2200133","type":"CDM"},{"code":"360","type":"RC"},{"code":"22633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Lat Thorax Spine Fusion","code_information":[{"code":"2200143","type":"CDM"},{"code":"360","type":"RC"},{"code":"22532","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Arthrodesis Lat Extracavitary Technique","code_information":[{"code":"2200145","type":"CDM"},{"code":"360","type":"RC"},{"code":"22534","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Arthrodesis Posterior Interbody Techniqu","code_information":[{"code":"2200153","type":"CDM"},{"code":"360","type":"RC"},{"code":"22632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Lumbar Spine Fusion","code_information":[{"code":"2200155","type":"CDM"},{"code":"360","type":"RC"},{"code":"22630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Neck Spine Fusion","code_information":[{"code":"2200157","type":"CDM"},{"code":"360","type":"RC"},{"code":"22600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Arthrodesis Post Or Posterolat Tech","code_information":[{"code":"2200159","type":"CDM"},{"code":"360","type":"RC"},{"code":"22614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Lumbar Spine Fusion","code_information":[{"code":"2200161","type":"CDM"},{"code":"360","type":"RC"},{"code":"22612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Thorax Spine Fusion","code_information":[{"code":"2200163","type":"CDM"},{"code":"360","type":"RC"},{"code":"22610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Post Fusion 7-12 Vert Seg","code_information":[{"code":"2200165","type":"CDM"},{"code":"360","type":"RC"},{"code":"22802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Fusion Of Sacroiliac Joint","code_information":[{"code":"2200168","type":"CDM"},{"code":"360","type":"RC"},{"code":"27280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Total Hip Arthroplasty","code_information":[{"code":"2200180","type":"CDM"},{"code":"360","type":"RC"},{"code":"27130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Exploration Spinal Fusion","code_information":[{"code":"2201246","type":"CDM"},{"code":"360","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1508,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Insertion Interbody Biomechanical Device","code_information":[{"code":"2201545","type":"CDM"},{"code":"360","type":"RC"},{"code":"22853","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Ins Intervertebral Miomechanical Device","code_information":[{"code":"2201547","type":"CDM"},{"code":"360","type":"RC"},{"code":"22854","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Lamin/facet&foramin Sgl Vrtbrl Sgmt Lumb","code_information":[{"code":"2201593","type":"CDM"},{"code":"360","type":"RC"},{"code":"63047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Excise Intrspinl Lesion Lmbr","code_information":[{"code":"2201597","type":"CDM"},{"code":"360","type":"RC"},{"code":"63267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Implant Neuroelectrodes","code_information":[{"code":"2201599","type":"CDM"},{"code":"360","type":"RC"},{"code":"63655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Remove Lamina/facets Lumbar","code_information":[{"code":"2201601","type":"CDM"},{"code":"360","type":"RC"},{"code":"63012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Remove Spine Lamina 1 Crvl","code_information":[{"code":"2201603","type":"CDM"},{"code":"360","type":"RC"},{"code":"63045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Laminectomy Facetectomy And Foraminotomy","code_information":[{"code":"2201605","type":"CDM"},{"code":"360","type":"RC"},{"code":"63048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Remove Spine Lamina 1 Thrc","code_information":[{"code":"2201607","type":"CDM"},{"code":"360","type":"RC"},{"code":"63046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"C-laminoplasty W/graft/plate","code_information":[{"code":"2201611","type":"CDM"},{"code":"360","type":"RC"},{"code":"63051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Laminotomy Single Cervical","code_information":[{"code":"2201613","type":"CDM"},{"code":"360","type":"RC"},{"code":"63040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Laminotomy Single Ea Add Cervical","code_information":[{"code":"2201615","type":"CDM"},{"code":"360","type":"RC"},{"code":"63043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Laminotomy Single Ea Add Lumbar","code_information":[{"code":"2201617","type":"CDM"},{"code":"360","type":"RC"},{"code":"63044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Laminotomy Single Lumbar","code_information":[{"code":"2201619","type":"CDM"},{"code":"360","type":"RC"},{"code":"63042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Laminotomy Single Cervical/lumbar","code_information":[{"code":"2201621","type":"CDM"},{"code":"360","type":"RC"},{"code":"63035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Neck Spine Disk Surgery","code_information":[{"code":"2201623","type":"CDM"},{"code":"360","type":"RC"},{"code":"63020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1232,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Low Back Disk Surgery","code_information":[{"code":"2201625","type":"CDM"},{"code":"360","type":"RC"},{"code":"63030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Pelvic Fixation Attachment Caudal End","code_information":[{"code":"2202167","type":"CDM"},{"code":"360","type":"RC"},{"code":"22848","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Implant Neuroelectrodes","code_information":[{"code":"2202169","type":"CDM"},{"code":"360","type":"RC"},{"code":"63650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1058,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Implant Neuroelectrodes","code_information":[{"code":"2202173","type":"CDM"},{"code":"360","type":"RC"},{"code":"64561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1232,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Perq Lamot/lam Lumbar","code_information":[{"code":"2202175","type":"CDM"},{"code":"360","type":"RC"},{"code":"0275T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Perq Vertebral Augmentation Lu","code_information":[{"code":"2202205","type":"CDM"},{"code":"360","type":"RC"},{"code":"22514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Perq Vertebral Augmentation Th","code_information":[{"code":"2202207","type":"CDM"},{"code":"360","type":"RC"},{"code":"22513","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1665,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Perc Vertebroplasty Bone Biopsy","code_information":[{"code":"2202213","type":"CDM"},{"code":"360","type":"RC"},{"code":"22512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Perq Lumbosacral Injection","code_information":[{"code":"2202215","type":"CDM"},{"code":"360","type":"RC"},{"code":"22511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1508,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Post Nonsegmental Instr Eg Harrington","code_information":[{"code":"2202243","type":"CDM"},{"code":"360","type":"RC"},{"code":"22840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Posterior Segmental Instrumentation","code_information":[{"code":"2202245","type":"CDM"},{"code":"360","type":"RC"},{"code":"22844","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Posterior Segmental Instrumentation","code_information":[{"code":"2202247","type":"CDM"},{"code":"360","type":"RC"},{"code":"22842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Reinsertion Spinal Fixation Device","code_information":[{"code":"2202322","type":"CDM"},{"code":"360","type":"RC"},{"code":"22849","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Removal Anterior Instrumentation","code_information":[{"code":"2202350","type":"CDM"},{"code":"360","type":"RC"},{"code":"22855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Remove Spine Fixation Device","code_information":[{"code":"2202381","type":"CDM"},{"code":"360","type":"RC"},{"code":"22850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Remove Spine Eltrd Plate","code_information":[{"code":"2202397","type":"CDM"},{"code":"360","type":"RC"},{"code":"63662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Revise Cerv Artific Disc","code_information":[{"code":"2202597","type":"CDM"},{"code":"360","type":"RC"},{"code":"22861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Revise Spine Eltrd Perq Aray","code_information":[{"code":"2202599","type":"CDM"},{"code":"360","type":"RC"},{"code":"63663","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Revise Spine Eltrd Plate","code_information":[{"code":"2202601","type":"CDM"},{"code":"360","type":"RC"},{"code":"63664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Revise Hip Joint Replacement","code_information":[{"code":"2202609","type":"CDM"},{"code":"360","type":"RC"},{"code":"27134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Revise Hip Joint Replacement","code_information":[{"code":"2202611","type":"CDM"},{"code":"360","type":"RC"},{"code":"27138","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Revise/remove Neuroreceiver","code_information":[{"code":"2202619","type":"CDM"},{"code":"360","type":"RC"},{"code":"63688","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Tot Disc Arthroplasty Anterior Approach","code_information":[{"code":"2202811","type":"CDM"},{"code":"360","type":"RC"},{"code":"22858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Cerv Artific Diskectomy","code_information":[{"code":"2202813","type":"CDM"},{"code":"360","type":"RC"},{"code":"22856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Lumbar Artif Diskectomy","code_information":[{"code":"2202817","type":"CDM"},{"code":"360","type":"RC"},{"code":"22857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Transped Appr W Decompression Spinal Cr","code_information":[{"code":"2202835","type":"CDM"},{"code":"360","type":"RC"},{"code":"63057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":924,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Decompress Spinal Cord Lmbr","code_information":[{"code":"2202837","type":"CDM"},{"code":"360","type":"RC"},{"code":"63056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":1868,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Or Level 6 Each Add'l Min","code_information":[{"code":"2202993","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202993","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Picasso Ii 6.0x85mm Curved Rod","code_information":[{"code":"2800352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Picasso Ii Curved 50mm Rod","code_information":[{"code":"2800356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Picasso Ii Curved Rod 60mm","code_information":[{"code":"2800357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Picasso Pre Bent 75mm Rod","code_information":[{"code":"2800360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Picasso Pre Bent 80mm Rod","code_information":[{"code":"2800361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Tl Amedica Curved Rod .6mmx 45mm","code_information":[{"code":"2800666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Tl Medical 70mm Curved Rod","code_information":[{"code":"2800676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Testosterone Free","code_information":[{"code":"4000357","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":350,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Clsd Tx Talus Fract Wo Manip","code_information":[{"code":"8500229","type":"CDM"},{"code":"28430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348,"maximum":924,"gross_charge":435,"discounted_cash":435,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":348}]}]},{"description":"Stryker Kwire With Stop 1.5mm L150mm","code_information":[{"code":"2800505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":348,"maximum":348,"gross_charge":435,"discounted_cash":435,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":348}]}]},{"description":"Removal Foreign Body Upper Arm Or Elbow","code_information":[{"code":"8500168","type":"CDM"},{"code":"24200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348,"maximum":348,"gross_charge":435,"discounted_cash":435,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":348}]}]},{"description":"Reposition Gastrostomy Tube","code_information":[{"code":"8400295","type":"CDM"},{"code":"450","type":"RC"},{"code":"43761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":346,"maximum":924,"gross_charge":432,"discounted_cash":432,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Bldr Irrigation Smpl Lvg&/instlj","code_information":[{"code":"8400302","type":"CDM"},{"code":"450","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":346,"maximum":924,"gross_charge":432,"discounted_cash":432,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Glucagon Hydrochloride/1 Mg","code_information":[{"code":"8400899","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":346,"maximum":346,"gross_charge":432,"discounted_cash":432,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Smpl Rpr S/n/s/g/t 12.6 To 20.0cm","code_information":[{"code":"8500098","type":"CDM"},{"code":"12005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":346,"maximum":1058,"gross_charge":432,"discounted_cash":432,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Stryker Bone Screw T10 Full Thread 3.5mm","code_information":[{"code":"2800471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":345,"maximum":345,"gross_charge":431,"discounted_cash":431,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":345}]}]},{"description":"Stryker Bone Screw T10 Full Thread 3.5mm","code_information":[{"code":"2800473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":345,"maximum":345,"gross_charge":431,"discounted_cash":431,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":345}]}]},{"description":"Strykre Bone Screw 3.5/l32","code_information":[{"code":"2800551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":345,"maximum":345,"gross_charge":431,"discounted_cash":431,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":345}]}]},{"description":"Cyanocobalamin B12 Unsaturated Binding","code_information":[{"code":"4000123","type":"CDM"},{"code":"300","type":"RC"},{"code":"82608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":343,"maximum":343,"gross_charge":429,"discounted_cash":429,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":343}]}]},{"description":"Tx Superficial Wnd Dehisc Smpl Clsr W/pk","code_information":[{"code":"8500106","type":"CDM"},{"code":"12021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":342,"maximum":924,"gross_charge":428,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":342}]}]},{"description":"Fibrin Degradation Ddimer","code_information":[{"code":"4000144","type":"CDM"},{"code":"300","type":"RC"},{"code":"85380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":342,"maximum":342,"gross_charge":428,"discounted_cash":428,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":342}]}]},{"description":"Fibrin Dgradj Produxs D-dimer Ultrsens","code_information":[{"code":"8400619","type":"CDM"},{"code":"300","type":"RC"},{"code":"85380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":342,"maximum":342,"gross_charge":428,"discounted_cash":428,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":342}]}]},{"description":"Drainage Finger Abscess Simple","code_information":[{"code":"8500188","type":"CDM"},{"code":"26010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":341,"maximum":341,"gross_charge":426,"discounted_cash":426,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":341}]}]},{"description":"Closed Tx Nasal Fracture W/o Stabiliz","code_information":[{"code":"8500153","type":"CDM"},{"code":"21315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":1058,"gross_charge":422,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"Bnpb Type Natriuretic Peptide","code_information":[{"code":"8400558","type":"CDM"},{"code":"300","type":"RC"},{"code":"83880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":337,"maximum":337,"gross_charge":421,"discounted_cash":421,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":337}]}]},{"description":"Cerv Flexible Non-adjustable","code_information":[{"code":"8401328","type":"CDM"},{"code":"450","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":337,"maximum":337,"gross_charge":421,"discounted_cash":421,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":337}]}]},{"description":"Stryker Bone Screw Full Thread 2.4/14mm","code_information":[{"code":"2800469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":336,"gross_charge":420,"discounted_cash":420,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"Stryker Bone Screw Full Thread 2.4/18mm","code_information":[{"code":"2800470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":336,"gross_charge":420,"discounted_cash":420,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"Stryker Bone Screw T6 2.0mm L12mm","code_information":[{"code":"2800474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":336,"gross_charge":420,"discounted_cash":420,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"Stryker Bone Screw T8 Full Thread 2.7mm","code_information":[{"code":"2800475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":336,"gross_charge":420,"discounted_cash":420,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"Styker Bone Screw Full Thread 2.4x24mm","code_information":[{"code":"2800552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":336,"gross_charge":420,"discounted_cash":420,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"Neuromuscular Reeducation","code_information":[{"code":"6100024","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":335,"gross_charge":419,"discounted_cash":419,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Neuromuscular Re-education: Therapeutic","code_information":[{"code":"6100035","type":"CDM"},{"code":"424","type":"RC"},{"code":"97112","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":335,"gross_charge":419,"discounted_cash":419,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Neuromuscular Re-education: Therapeutic","code_information":[{"code":"6100036","type":"CDM"},{"code":"424","type":"RC"},{"code":"97112","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":335,"gross_charge":419,"discounted_cash":419,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Ultane 250 Ml","code_information":[{"code":"3000308","type":"CDM"},{"code":"636","type":"RC"},{"code":"66794001525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":332,"maximum":332,"gross_charge":415,"discounted_cash":415,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":332}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Blood Occult Neoplasm Screen","code_information":[{"code":"4000078","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":332,"maximum":332,"gross_charge":415,"discounted_cash":415,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":332}]}]},{"description":"Path Consult Frozen Sections Single Spec","code_information":[{"code":"4000312","type":"CDM"},{"code":"310","type":"RC"},{"code":"88331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":331,"maximum":331,"gross_charge":414,"discounted_cash":414,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"Fibrin Degradation Products D-dimer; Qua","code_information":[{"code":"4000269","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":331,"maximum":331,"gross_charge":414,"discounted_cash":414,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"Fibrin Dgradj Produxs D-dimer Quan","code_information":[{"code":"8400618","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":331,"maximum":331,"gross_charge":414,"discounted_cash":414,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"Volatiles Eg Acetic Anhydride Carbon","code_information":[{"code":"4000393","type":"CDM"},{"code":"300","type":"RC"},{"code":"84600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":330,"maximum":330,"gross_charge":413,"discounted_cash":413,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":330}]}]},{"description":"Clsd Tx Phalangeal Shaft Fract Wo","code_information":[{"code":"8500201","type":"CDM"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":330,"maximum":924,"gross_charge":412,"discounted_cash":412,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":330}]}]},{"description":"Debride Nail 1-6","code_information":[{"code":"1000087","type":"CDM"},{"code":"450","type":"RC"},{"code":"11720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":327,"maximum":924,"gross_charge":409,"discounted_cash":409,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":327}]}]},{"description":"X Ray Exam Femur 2 Views","code_information":[{"code":"8401496","type":"CDM"},{"code":"329","type":"RC"},{"code":"73550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":326,"gross_charge":408,"discounted_cash":408,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"Clsd Tx Fract Phlnx/phlng W/m","code_information":[{"code":"8500234","type":"CDM"},{"code":"28515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":924,"gross_charge":408,"discounted_cash":408,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"Clsd Tx Mcp Joint Dislocation Wo Anes","code_information":[{"code":"8500235","type":"CDM"},{"code":"28630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":924,"gross_charge":408,"discounted_cash":408,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"Pt Self Care/home Mgmt Training","code_information":[{"code":"6100016","type":"CDM"},{"code":"420","type":"RC"},{"code":"97535","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":326,"gross_charge":407,"discounted_cash":407,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Elf-care/home Management Training (E.g.,","code_information":[{"code":"6100039","type":"CDM"},{"code":"424","type":"RC"},{"code":"97535","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":326,"gross_charge":407,"discounted_cash":407,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Elf-care/home Management Training (E.g.,","code_information":[{"code":"6100040","type":"CDM"},{"code":"424","type":"RC"},{"code":"97535","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":326,"gross_charge":407,"discounted_cash":407,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Excision Nail Matrix Permanent Removal","code_information":[{"code":"8500091","type":"CDM"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":325,"maximum":924,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":325}]}]},{"description":"S&n Tapered 3.8","code_information":[{"code":"2800793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":324,"maximum":324,"gross_charge":405,"discounted_cash":405,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":324}]}]},{"description":"Oxycontin 10mg Tab","code_information":[{"code":"3000232","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":323,"maximum":323,"gross_charge":404,"discounted_cash":404,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":323}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ferritin","code_information":[{"code":"4000142","type":"CDM"},{"code":"300","type":"RC"},{"code":"82728","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":322,"gross_charge":403,"discounted_cash":403,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Culture Chlamydia Any Source","code_information":[{"code":"4000115","type":"CDM"},{"code":"300","type":"RC"},{"code":"87110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":322,"gross_charge":403,"discounted_cash":403,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Culture Bacterial Anaerobic Isolate","code_information":[{"code":"4000263","type":"CDM"},{"code":"300","type":"RC"},{"code":"87076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":322,"gross_charge":403,"discounted_cash":403,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Noninvasive Ear Or Pulse Oximetry","code_information":[{"code":"1000189","type":"CDM"},{"code":"450","type":"RC"},{"code":"94762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":322,"gross_charge":403,"discounted_cash":403,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Clsd Tx Distal Phalangeal Fract Wo Manip","code_information":[{"code":"8500204","type":"CDM"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":322,"gross_charge":403,"discounted_cash":403,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Clsd Tx Ip Joint Disloc Wo/anes","code_information":[{"code":"8500236","type":"CDM"},{"code":"28660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":924,"gross_charge":403,"discounted_cash":403,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Cytopathology Smears Any Other Source","code_information":[{"code":"4000124","type":"CDM"},{"code":"300","type":"RC"},{"code":"88161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":322,"gross_charge":402,"discounted_cash":402,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Cytopath Smear Other Source","code_information":[{"code":"8400785","type":"CDM"},{"code":"300","type":"RC"},{"code":"88161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":322,"gross_charge":402,"discounted_cash":402,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Encl/exc Xtrnl Thrombotic Hemorrhoid","code_information":[{"code":"8500299","type":"CDM"},{"code":"46320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":321,"maximum":924,"gross_charge":401,"discounted_cash":401,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":321}]}]},{"description":"Prednisolone (Orapred) Oral Sol 15mg/5ml","code_information":[{"code":"3060829","type":"CDM"},{"code":"258","type":"RC"},{"code":"68135045502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":319,"maximum":319,"gross_charge":399,"discounted_cash":399,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":319}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Evacuation Subungual Hematoma","code_information":[{"code":"8400090","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":318,"maximum":924,"gross_charge":397,"discounted_cash":397,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":318}]}]},{"description":"Drain Ext Ear Abscess/hematoma Simple","code_information":[{"code":"8500342","type":"CDM"},{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":318,"maximum":924,"gross_charge":397,"discounted_cash":397,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":318}]}]},{"description":"Basic metabolic panel","code_information":[{"code":"4000252","type":"CDM"},{"code":"301","type":"RC"},{"code":"80048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":317,"maximum":317,"gross_charge":396,"discounted_cash":396,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":317}]}]},{"description":"Ascerta 4.8x26 Stent","code_information":[{"code":"2800104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":316,"gross_charge":395,"discounted_cash":395,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Ascerta 7 X 26 Ureteral Stent","code_information":[{"code":"2800107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":316,"gross_charge":395,"discounted_cash":395,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Bard Ureteral Stent 7frx 26cm","code_information":[{"code":"2800126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":316,"gross_charge":395,"discounted_cash":395,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Valproic Acid Dipropylacetic Acid Free","code_information":[{"code":"4000388","type":"CDM"},{"code":"300","type":"RC"},{"code":"80165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":316,"gross_charge":395,"discounted_cash":395,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Procalcitonin 48932","code_information":[{"code":"4000324","type":"CDM"},{"code":"300","type":"RC"},{"code":"84145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":316,"gross_charge":395,"discounted_cash":395,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"I&d Vulva/prnl Absc","code_information":[{"code":"8500311","type":"CDM"},{"code":"56405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":315,"maximum":1058,"gross_charge":394,"discounted_cash":394,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"Iv Psh Thr Prph/dx Njx Iv Psh S/1st Sbst","code_information":[{"code":"8400391","type":"CDM"},{"code":"450","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":314,"gross_charge":393,"discounted_cash":393,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Fetal Non Stress Test","code_information":[{"code":"8500315","type":"CDM"},{"code":"59025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":314,"maximum":314,"gross_charge":393,"discounted_cash":393,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":314}]}]},{"description":"Level Ii Pathology Gross And Micro Exam","code_information":[{"code":"4000286","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":314,"maximum":314,"gross_charge":392,"discounted_cash":392,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":314}]}]},{"description":"Tx Superficial Wnd Dehiscence Smpl Closr","code_information":[{"code":"8500105","type":"CDM"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":314,"maximum":924,"gross_charge":392,"discounted_cash":392,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":314}]}]},{"description":"Insert Bladder Catheter","code_information":[{"code":"1000174","type":"CDM"},{"code":"450","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":312,"maximum":924,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":312}]}]},{"description":"Repair Inter F/e/e/n/l/m&/muc 2.5 Cm/<","code_information":[{"code":"8500115","type":"CDM"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":312,"maximum":924,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":312}]}]},{"description":"Clsd Tx Fract Grt Toe Phlnx/phlng W/mnp","code_information":[{"code":"8500232","type":"CDM"},{"code":"28495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":312,"maximum":924,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":312}]}]},{"description":"Incision Of Anal Abscess","code_information":[{"code":"8500297","type":"CDM"},{"code":"46050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":311,"maximum":924,"gross_charge":389,"discounted_cash":389,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":311}]}]},{"description":"Cardiopulm Resuscitation (Cpr)","code_information":[{"code":"8500358","type":"CDM"},{"code":"92950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":311,"gross_charge":389,"discounted_cash":389,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Pneumothor Set Cath Pigtail Ndl 18g 14fr","code_information":[{"code":"8401243","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"PNEU"}],"standard_charges":[{"setting":"outpatient","modifier_code":["PNEU"],"minimum":310,"maximum":310,"gross_charge":388,"discounted_cash":388,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":310}]}]},{"description":"Cerv Semi-rig Adj Molded Chn","code_information":[{"code":"8401329","type":"CDM"},{"code":"450","type":"RC"},{"code":"L0150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":310,"maximum":310,"gross_charge":388,"discounted_cash":388,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":310}]}]},{"description":"Incision&drain Pilonidal Cyst Comp","code_information":[{"code":"8500071","type":"CDM"},{"code":"10081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":309,"maximum":924,"gross_charge":386,"discounted_cash":386,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":309}]}]},{"description":"Incision&removal Fb Subq Tiss Comp","code_information":[{"code":"8500073","type":"CDM"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":308,"maximum":1058,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":308}]}]},{"description":"Removal Foreign Body Mouth","code_information":[{"code":"8500284","type":"CDM"},{"code":"40804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":308,"maximum":308,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":308}]}]},{"description":"Ascerta 6 X 28 Ureteral Stent","code_information":[{"code":"2800105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":306,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Ascerta 6x22 Ureteral Stent","code_information":[{"code":"2800106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":306,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Ascerta Uretreal Stent 6x24","code_information":[{"code":"2800109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":306,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"B.s. Stent 6 X 24cm","code_information":[{"code":"2800121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":306,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Treatment Of Penis Lesion","code_information":[{"code":"8500307","type":"CDM"},{"code":"54220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":924,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Visual Acuity Screening","code_information":[{"code":"8400411","type":"CDM"},{"code":"450","type":"RC"},{"code":"99173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":306,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Tissue Cult For Nonneoplastic Disorders","code_information":[{"code":"4000365","type":"CDM"},{"code":"300","type":"RC"},{"code":"88233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":306,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Tiss Cult Non-neoplastic Disorders","code_information":[{"code":"8400786","type":"CDM"},{"code":"300","type":"RC"},{"code":"88233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":306,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Tissue Exam By Pathologist","code_information":[{"code":"8400787","type":"CDM"},{"code":"300","type":"RC"},{"code":"88305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":306,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Lead","code_information":[{"code":"4000283","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":304,"maximum":304,"gross_charge":380,"discounted_cash":380,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":304}]}]},{"description":"Fine Needle Aspiration Wo Imaging Guid","code_information":[{"code":"8500066","type":"CDM"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":304,"maximum":924,"gross_charge":380,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":304}]}]},{"description":"Drain Lymph Node Absc/lymphadenitis Smpl","code_information":[{"code":"8500281","type":"CDM"},{"code":"38300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":303,"maximum":924,"gross_charge":379,"discounted_cash":379,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":303}]}]},{"description":"Potassium Urine","code_information":[{"code":"4000322","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":302,"gross_charge":378,"discounted_cash":378,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302}]}]},{"description":"Culture Bacterial Blood Aerobic With Iso","code_information":[{"code":"4000266","type":"CDM"},{"code":"300","type":"RC"},{"code":"87040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":302,"gross_charge":378,"discounted_cash":378,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302}]}]},{"description":"Treat Hip Dislocation","code_information":[{"code":"8500207","type":"CDM"},{"code":"27250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":301,"maximum":924,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":301}]}]},{"description":"Drg Absc Cst Hmtma Dentoalveolar Struxs","code_information":[{"code":"8500288","type":"CDM"},{"code":"41800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":301,"maximum":924,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":301}]}]},{"description":"Culture Bacteria Anaerobic","code_information":[{"code":"4000265","type":"CDM"},{"code":"300","type":"RC"},{"code":"87075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":300,"gross_charge":375,"discounted_cash":375,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Cul Bact Bld Anaerc Isol","code_information":[{"code":"8400712","type":"CDM"},{"code":"300","type":"RC"},{"code":"87075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":300,"gross_charge":375,"discounted_cash":375,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Monet Fa Self Drilling 3.52x14mm","code_information":[{"code":"2800316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":300,"gross_charge":375,"discounted_cash":375,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Monet Fa Self Drilling 4.0x14mm","code_information":[{"code":"2800317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":300,"gross_charge":375,"discounted_cash":375,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Monet Fixed Angle 3.5x 14 Mm Slf Tgng Sc","code_information":[{"code":"2800320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":300,"gross_charge":375,"discounted_cash":375,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Monet Fixed Angle Slf Tapping Screw 3.5x","code_information":[{"code":"2800321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":300,"gross_charge":375,"discounted_cash":375,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Intubation Endotracheal Emergency Proced","code_information":[{"code":"8500261","type":"CDM"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":924,"gross_charge":374,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":299}]}]},{"description":"Wear Ecg24hr W/vis Supimpos Scn Phys R&i","code_information":[{"code":"8400366","type":"CDM"},{"code":"450","type":"RC"},{"code":"93224","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":299,"gross_charge":374,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Liver function blood test","code_information":[{"code":"4000173","type":"CDM"},{"code":"301","type":"RC"},{"code":"80076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":299,"gross_charge":374,"discounted_cash":374,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":299}]}]},{"description":"Massage Therapy","code_information":[{"code":"6100023","type":"CDM"},{"code":"420","type":"RC"},{"code":"97124","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":298,"gross_charge":373,"discounted_cash":373,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Stroking Compression","code_information":[{"code":"6100061","type":"CDM"},{"code":"424","type":"RC"},{"code":"97124","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":298,"gross_charge":373,"discounted_cash":373,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Stroking Compression","code_information":[{"code":"6100062","type":"CDM"},{"code":"424","type":"RC"},{"code":"97124","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":298,"gross_charge":373,"discounted_cash":373,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Insj Temp Ndwellg Bldr Cath Comp","code_information":[{"code":"8500305","type":"CDM"},{"code":"51703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":924,"gross_charge":373,"discounted_cash":373,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Synthes Mini 1.5mm X 12mm Cortical Screw","code_information":[{"code":"2800639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":298,"gross_charge":373,"discounted_cash":373,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Liver function blood test","code_information":[{"code":"8400456","type":"CDM"},{"code":"301","type":"RC"},{"code":"80076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":298,"gross_charge":372,"discounted_cash":372,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Xr Mastoids Less Than 3 Views Per Side","code_information":[{"code":"8401428","type":"CDM"},{"code":"359","type":"RC"},{"code":"70120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":296,"maximum":296,"gross_charge":370,"discounted_cash":370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Synthes 4.0 Cancellous Screw 14m","code_information":[{"code":"2800611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":296,"maximum":296,"gross_charge":370,"discounted_cash":370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Synthes 4.0 Cancellous Screw 18m","code_information":[{"code":"2800612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":296,"maximum":296,"gross_charge":370,"discounted_cash":370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Synthes 4.0 Cancellous Screw 20mm","code_information":[{"code":"2800613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":296,"maximum":296,"gross_charge":370,"discounted_cash":370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Synthes 4.00mm Cnacllous Bone Screw Full","code_information":[{"code":"2800614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":296,"maximum":296,"gross_charge":370,"discounted_cash":370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Synthes 4.0mm Cancellous Bone 16mm","code_information":[{"code":"2800615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":296,"maximum":296,"gross_charge":370,"discounted_cash":370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Synthes Cancellous Screw 60mm","code_information":[{"code":"2800625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":296,"maximum":296,"gross_charge":370,"discounted_cash":370,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Cont Intraop Neuromonitoring Outside Or","code_information":[{"code":"2200589","type":"CDM"},{"code":"740","type":"RC"},{"code":"95940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295,"maximum":2300,"gross_charge":369,"discounted_cash":369,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2300}]}]},{"description":"Infusion Supplies With Pump","code_information":[{"code":"8401175","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":294,"maximum":294,"gross_charge":367,"discounted_cash":367,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":294}]}]},{"description":"Nerve Block Anes Other Prph Nrv/branch","code_information":[{"code":"8500328","type":"CDM"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294,"maximum":924,"gross_charge":367,"discounted_cash":367,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":294}]}]},{"description":"Smpl Rpr S/n/s/g/t 20.1cm To 30.0cm","code_information":[{"code":"8500099","type":"CDM"},{"code":"12006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":1058,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Pt Gait Training","code_information":[{"code":"6100018","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"6100033","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"6100034","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Functional Ambulation","code_information":[{"code":"6100049","type":"CDM"},{"code":"424","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pt Functional Ambulation","code_information":[{"code":"6100050","type":"CDM"},{"code":"424","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Therap Prc 1/> Areas Ea 15 Min Gait Trn","code_information":[{"code":"8400395","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Therap Prc 1/> Areas Ea 15 Min Gait Trn","code_information":[{"code":"8500395","type":"CDM"},{"code":"97116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Depuy Synthes 4.5mm Cortex Screw 26mm","code_information":[{"code":"2800192","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Depuy Synthes 4.5mm Cortex Screw 30mm","code_information":[{"code":"2800193","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Depuy Synthes 4.5mm Cortex Screw 32mm","code_information":[{"code":"2800194","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"J&j 4.5mm Cortex Screw Self Tapping 50mm","code_information":[{"code":"2800243","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"J&j 4.5mm Cortex Screw Self Tapping 54mm","code_information":[{"code":"2800244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"J&j 4.5mm Cortex Screw Self Tapping 70mm","code_information":[{"code":"2800245","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Synthes 28mm Cortex Screw","code_information":[{"code":"2800585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Synthes 4.5x38mm Cortex Screw","code_information":[{"code":"2800618","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Synthes Jj 4.5mm Cortex Screw","code_information":[{"code":"2800629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Synthes Screw 4.5 Cortex 5mm 36mm","code_information":[{"code":"2800644","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Electrolyte Panel","code_information":[{"code":"4000137","type":"CDM"},{"code":"300","type":"RC"},{"code":"80051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Electrolyte Panel","code_information":[{"code":"8400452","type":"CDM"},{"code":"300","type":"RC"},{"code":"80051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":292,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Blood test, lipids","code_information":[{"code":"4000293","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":291,"maximum":291,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291}]}]},{"description":"Blood test, lipids","code_information":[{"code":"8400454","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":291,"maximum":291,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291}]}]},{"description":"Spinal Tap Fluid","code_information":[{"code":"8500318","type":"CDM"},{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":291,"maximum":924,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291}]}]},{"description":"Spinal Punct Therapuetic","code_information":[{"code":"8500319","type":"CDM"},{"code":"62272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":291,"maximum":924,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291}]}]},{"description":"Sodium Bicarbonate 4.2% 5ml","code_information":[{"code":"3000268","type":"CDM"},{"code":"636","type":"RC"},{"code":"40949","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":290,"maximum":290,"gross_charge":363,"discounted_cash":363,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Repair Of Finger Tendon","code_information":[{"code":"8500191","type":"CDM"},{"code":"26418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":1508,"gross_charge":360,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Synthes 3.5 Cortex Screw 14","code_information":[{"code":"2800589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":288,"gross_charge":360,"discounted_cash":360,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Synthes 6.5mm X 110mm Screw","code_information":[{"code":"2800620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":288,"gross_charge":360,"discounted_cash":360,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Synthes 6.5mm X 50mm Screw","code_information":[{"code":"2800621","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":288,"gross_charge":360,"discounted_cash":360,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Injection Intra-arterial","code_information":[{"code":"8400390","type":"CDM"},{"code":"450","type":"RC"},{"code":"96373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":288,"gross_charge":360,"discounted_cash":360,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Remove Eyelid Foreign Body","code_information":[{"code":"8500341","type":"CDM"},{"code":"67938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":924,"gross_charge":360,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Dalteparin Sodium","code_information":[{"code":"8400904","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":287,"maximum":287,"gross_charge":359,"discounted_cash":359,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"Initial Observation Care Low Complexity","code_information":[{"code":"8500414","type":"CDM"},{"code":"99218","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":287,"maximum":287,"gross_charge":359,"discounted_cash":359,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"Progesterone","code_information":[{"code":"4000325","type":"CDM"},{"code":"300","type":"RC"},{"code":"84144","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":287,"maximum":287,"gross_charge":359,"discounted_cash":359,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"General Hlth Panel","code_information":[{"code":"8400451","type":"CDM"},{"code":"300","type":"RC"},{"code":"80050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":286,"maximum":286,"gross_charge":358,"discounted_cash":358,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":286}]}]},{"description":"Cpeptide","code_information":[{"code":"4000100","type":"CDM"},{"code":"300","type":"RC"},{"code":"84681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":286,"maximum":286,"gross_charge":358,"discounted_cash":358,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":286}]}]},{"description":"Immunoassay For Tumor Antigen","code_information":[{"code":"4000187","type":"CDM"},{"code":"300","type":"RC"},{"code":"86304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":286,"maximum":286,"gross_charge":358,"discounted_cash":358,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":286}]}]},{"description":"General Health Panel","code_information":[{"code":"4000158","type":"CDM"},{"code":"300","type":"RC"},{"code":"80050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":286,"maximum":286,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":286}]}]},{"description":"Application Finger Splint Dynamic","code_information":[{"code":"8400243","type":"CDM"},{"code":"450","type":"RC"},{"code":"29131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":286,"maximum":286,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":286}]}]},{"description":"Sleeve For Intermittent Limb Compression","code_information":[{"code":"28000748","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":284,"maximum":284,"gross_charge":355,"discounted_cash":355,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":284}]}]},{"description":"Axillary Crutch Extension","code_information":[{"code":"8401331","type":"CDM"},{"code":"450","type":"RC"},{"code":"L0978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":283,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283}]}]},{"description":"Basic metabolic panel","code_information":[{"code":"8400450","type":"CDM"},{"code":"301","type":"RC"},{"code":"80048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":283,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283}]}]},{"description":"Imm Admin 18 Yr/< Of Age","code_information":[{"code":"8400350","type":"CDM"},{"code":"450","type":"RC"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":282,"maximum":282,"gross_charge":353,"discounted_cash":353,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":282}]}]},{"description":"Special Stains List Sep In Addit To Code","code_information":[{"code":"4000349","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":282,"maximum":282,"gross_charge":352,"discounted_cash":352,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":282}]}]},{"description":"Simple Repair F/e/e/n/l/m 12.6cm-20.0cm","code_information":[{"code":"8500104","type":"CDM"},{"code":"12016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":281,"maximum":1058,"gross_charge":351,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":281}]}]},{"description":"Cephied Infect Dis Rna","code_information":[{"code":"8400448","type":"CDM"},{"code":"300","type":"RC"},{"code":"0241U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":280,"maximum":280,"gross_charge":350,"discounted_cash":350,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Culture Tubercle/other Acid-fast Bacilli","code_information":[{"code":"4000119","type":"CDM"},{"code":"300","type":"RC"},{"code":"87116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":280,"maximum":280,"gross_charge":350,"discounted_cash":350,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Mycobacteria Culture","code_information":[{"code":"8400719","type":"CDM"},{"code":"300","type":"RC"},{"code":"87116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":280,"maximum":280,"gross_charge":350,"discounted_cash":350,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Inf Agent Ant Det Chlamydia Trachomatis","code_information":[{"code":"4000211","type":"CDM"},{"code":"300","type":"RC"},{"code":"87270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":279,"maximum":279,"gross_charge":349,"discounted_cash":349,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"Blood Occult Peroxidase Activity","code_information":[{"code":"4000257","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":279,"maximum":279,"gross_charge":349,"discounted_cash":349,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"Repair Nail Bed","code_information":[{"code":"8500092","type":"CDM"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":924,"gross_charge":348,"discounted_cash":348,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278}]}]},{"description":"Repair Complex S/a/l Ea 5 Cm Or Less","code_information":[{"code":"8500124","type":"CDM"},{"code":"13122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":924,"gross_charge":348,"discounted_cash":348,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278}]}]},{"description":"Antibody Cytomegalovirus Cmv","code_information":[{"code":"4000023","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":278,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278}]}]},{"description":"Drainage Of Scrotum Abscess","code_information":[{"code":"8500310","type":"CDM"},{"code":"55100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":924,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278}]}]},{"description":"Sodium Urine","code_information":[{"code":"4000347","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":277,"maximum":277,"gross_charge":346,"discounted_cash":346,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":277}]}]},{"description":"Iv Hydration Subsequent","code_information":[{"code":"3100009","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":276,"gross_charge":345,"discounted_cash":345,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Antibody Respiratory Syncytial Virus","code_information":[{"code":"4000043","type":"CDM"},{"code":"300","type":"RC"},{"code":"86756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":276,"gross_charge":345,"discounted_cash":345,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Inf Agent Det Dna/rna Neisser Gonorrhoea","code_information":[{"code":"4000238","type":"CDM"},{"code":"300","type":"RC"},{"code":"87590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":276,"gross_charge":345,"discounted_cash":345,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Creatine Kinase (Ck) (Cpk); Mb Fraction","code_information":[{"code":"4000260","type":"CDM"},{"code":"300","type":"RC"},{"code":"82553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Troponin Quantitative","code_information":[{"code":"4000276","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Blood test, thyroid stimulating hormone (TSH)","code_information":[{"code":"4000362","type":"CDM"},{"code":"301","type":"RC"},{"code":"84443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Iv Nfs Ther Proph/dx Addl Seq Nfs >1 Hr","code_information":[{"code":"8400386","type":"CDM"},{"code":"450","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Ckmbcreatine Kinase Mb Fxj Only","code_information":[{"code":"8400519","type":"CDM"},{"code":"300","type":"RC"},{"code":"82553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Blood test, thyroid stimulating hormone (TSH)","code_information":[{"code":"8400584","type":"CDM"},{"code":"301","type":"RC"},{"code":"84443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Assay Of Vitamin E","code_information":[{"code":"8400585","type":"CDM"},{"code":"300","type":"RC"},{"code":"84446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Troponin Quan","code_information":[{"code":"8400594","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Blood Culturecul Bact Bld Aerc Isol","code_information":[{"code":"8400707","type":"CDM"},{"code":"300","type":"RC"},{"code":"87040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Removal Of Vaginal Foreign Object","code_information":[{"code":"8500313","type":"CDM"},{"code":"57415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":1058,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Repair Inter N/h/f/xtrnl Gent 2.5cm/<","code_information":[{"code":"8500111","type":"CDM"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":924,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Ecg Rout Ecg W/lst 12 Lds Trcg W/o I&r","code_information":[{"code":"8400361","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Clsd Tx Fract Phlnx/phlng Wo/m","code_information":[{"code":"8500233","type":"CDM"},{"code":"28510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":924,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Cardioversion Elective Arrhyt Xtrnl","code_information":[{"code":"8500359","type":"CDM"},{"code":"92960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":275,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Remove Impacted Ear Wax Uni","code_information":[{"code":"1000220","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":924,"gross_charge":342,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Remove Impacted Ear Wax Uni","code_information":[{"code":"8400346","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":924,"gross_charge":342,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Strapping Of Elbow Or Wrist","code_information":[{"code":"8400245","type":"CDM"},{"code":"450","type":"RC"},{"code":"29260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":273,"maximum":273,"gross_charge":341,"discounted_cash":341,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273}]}]},{"description":"Manual Therapy","code_information":[{"code":"6100010","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":273,"gross_charge":341,"discounted_cash":341,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Man Therapy","code_information":[{"code":"6100055","type":"CDM"},{"code":"424","type":"RC"},{"code":"97140","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":273,"gross_charge":341,"discounted_cash":341,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Man Therapy","code_information":[{"code":"6100056","type":"CDM"},{"code":"424","type":"RC"},{"code":"97140","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":273,"gross_charge":341,"discounted_cash":341,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Clsd Tx Radial Head Sublux Elbow W/manip","code_information":[{"code":"8500172","type":"CDM"},{"code":"24640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":273,"maximum":273,"gross_charge":341,"discounted_cash":341,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273}]}]},{"description":"Strapping Shoulder","code_information":[{"code":"8400244","type":"CDM"},{"code":"450","type":"RC"},{"code":"29240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":272,"maximum":272,"gross_charge":340,"discounted_cash":340,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":272}]}]},{"description":"Herpes Simplex Virus Hsv","code_information":[{"code":"4000114","type":"CDM"},{"code":"300","type":"RC"},{"code":"87255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":272,"maximum":272,"gross_charge":340,"discounted_cash":340,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":272}]}]},{"description":"Cul Chlamydia Any Src","code_information":[{"code":"8400718","type":"CDM"},{"code":"300","type":"RC"},{"code":"87110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":272,"maximum":272,"gross_charge":340,"discounted_cash":340,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":272}]}]},{"description":"Toxin Or Antitoxin Assay Tissue Culture","code_information":[{"code":"4000368","type":"CDM"},{"code":"300","type":"RC"},{"code":"87230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":271,"maximum":271,"gross_charge":339,"discounted_cash":339,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":271}]}]},{"description":"Excision Benign Lesion Trunk Arms O","code_information":[{"code":"8500086","type":"CDM"},{"code":"11404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":924,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Arthroplasty Ankle W/implant Add 1","code_information":[{"code":"2200182","type":"CDM"},{"code":"360","type":"RC"},{"code":"27702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1868,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Reconstruct Shoulder Joint","code_information":[{"code":"2200186","type":"CDM"},{"code":"360","type":"RC"},{"code":"23472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1665,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Total Knee Arthroplasty","code_information":[{"code":"2200194","type":"CDM"},{"code":"360","type":"RC"},{"code":"27447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1868,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Revision Of Knee Joint","code_information":[{"code":"2200196","type":"CDM"},{"code":"360","type":"RC"},{"code":"27446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1665,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Percutaneous Diskectomy","code_information":[{"code":"2200323","type":"CDM"},{"code":"360","type":"RC"},{"code":"62287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1665,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Total Hip Arthroplasty","code_information":[{"code":"2200601","type":"CDM"},{"code":"360","type":"RC"},{"code":"27132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1868,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Decompression Unspecified Nerves Specify","code_information":[{"code":"2200766","type":"CDM"},{"code":"360","type":"RC"},{"code":"64722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":924,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Donor Pancreatectomy Inc Cold Preserv","code_information":[{"code":"2200827","type":"CDM"},{"code":"360","type":"RC"},{"code":"48550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Partial Hip Replacement","code_information":[{"code":"2201326","type":"CDM"},{"code":"360","type":"RC"},{"code":"27125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1868,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Implant Spinal Canal Cath","code_information":[{"code":"2201373","type":"CDM"},{"code":"360","type":"RC"},{"code":"62350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1058,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Insert Self-contd Prosthesis","code_information":[{"code":"2201559","type":"CDM"},{"code":"360","type":"RC"},{"code":"54400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1232,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Bx/exc Xdrl Spine Lesn Lmbr","code_information":[{"code":"2201595","type":"CDM"},{"code":"360","type":"RC"},{"code":"63277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Cervical Laminoplsty 2/> Seg","code_information":[{"code":"2201609","type":"CDM"},{"code":"360","type":"RC"},{"code":"63050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Diag Laparo Separate Proc","code_information":[{"code":"2201637","type":"CDM"},{"code":"360","type":"RC"},{"code":"49320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1232,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Implant Neuroelectrodes","code_information":[{"code":"2202171","type":"CDM"},{"code":"360","type":"RC"},{"code":"64555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":924,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Perq Vertebral Augmentation","code_information":[{"code":"2202203","type":"CDM"},{"code":"360","type":"RC"},{"code":"22515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":924,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Perq Vertebral Augmentation Th","code_information":[{"code":"2202211","type":"CDM"},{"code":"360","type":"RC"},{"code":"22523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Repair Of Shoulder","code_information":[{"code":"2202302","type":"CDM"},{"code":"360","type":"RC"},{"code":"23420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":2196,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Repair Of Ruptured Tendon","code_information":[{"code":"2202320","type":"CDM"},{"code":"360","type":"RC"},{"code":"24342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1232,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Remove Spinal Canal Catheter","code_information":[{"code":"2202385","type":"CDM"},{"code":"360","type":"RC"},{"code":"62355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1058,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Remove Spine Eltrd Perq Aray","code_information":[{"code":"2202395","type":"CDM"},{"code":"360","type":"RC"},{"code":"63661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":924,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Rerepair Ventrl Hern Block","code_information":[{"code":"2202502","type":"CDM"},{"code":"360","type":"RC"},{"code":"49566","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Revise/replace Knee Joint","code_information":[{"code":"2202613","type":"CDM"},{"code":"360","type":"RC"},{"code":"27487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1868,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Revis Reconst Shoulder Joint","code_information":[{"code":"2202617","type":"CDM"},{"code":"360","type":"RC"},{"code":"23473","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":1665,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Total Disc Arthroplasty Anterior Approac","code_information":[{"code":"2202815","type":"CDM"},{"code":"360","type":"RC"},{"code":"0163T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Vertebral Corpectomy Vertebral Body Res","code_information":[{"code":"2202964","type":"CDM"},{"code":"360","type":"RC"},{"code":"63082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Remove Vert Body Dcmprn Crvl","code_information":[{"code":"2202966","type":"CDM"},{"code":"360","type":"RC"},{"code":"63081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Vertebr Corpectomy Vertebral Body Resect","code_information":[{"code":"2202968","type":"CDM"},{"code":"360","type":"RC"},{"code":"63088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Remov Vertbr Dcmprn Thrclmbr","code_information":[{"code":"2202970","type":"CDM"},{"code":"360","type":"RC"},{"code":"63087","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Vertebral Corpectomy Vertebral Body Rese","code_information":[{"code":"2202972","type":"CDM"},{"code":"360","type":"RC"},{"code":"63103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Remove Vert Body Dcmprn Thrc","code_information":[{"code":"2202974","type":"CDM"},{"code":"360","type":"RC"},{"code":"63101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Remove Vert Body Dcmprn Lmbr","code_information":[{"code":"2202976","type":"CDM"},{"code":"360","type":"RC"},{"code":"63090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Or Level 5 Each Add'l Min","code_information":[{"code":"2202991","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202991","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Culture Bacterial Stool Aerob W/isolatio","code_information":[{"code":"4000113","type":"CDM"},{"code":"300","type":"RC"},{"code":"87045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Cul Bct Stl Aerc Isl Salmonella&shigella","code_information":[{"code":"8400708","type":"CDM"},{"code":"300","type":"RC"},{"code":"87045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":270,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Inf Agent Detection Severe Acute Covid 2","code_information":[{"code":"4000246","type":"CDM"},{"code":"300","type":"RC"},{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":269,"gross_charge":336,"discounted_cash":336,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":269}]}]},{"description":"Chloride Blood","code_information":[{"code":"4000089","type":"CDM"},{"code":"300","type":"RC"},{"code":"82435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":268,"maximum":268,"gross_charge":335,"discounted_cash":335,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":268}]}]},{"description":"Basic Metabolic Panelionized Calcium","code_information":[{"code":"4000059","type":"CDM"},{"code":"300","type":"RC"},{"code":"80047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":267,"maximum":267,"gross_charge":334,"discounted_cash":334,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267}]}]},{"description":"Basic Metabolic Panel Calcium Ionized","code_information":[{"code":"8400449","type":"CDM"},{"code":"300","type":"RC"},{"code":"80047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":267,"maximum":267,"gross_charge":334,"discounted_cash":334,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267}]}]},{"description":"Synthes 1.5 Cortex Screw 14mm","code_information":[{"code":"2800560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":266,"gross_charge":333,"discounted_cash":333,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":266}]}]},{"description":"Antibody Herpes Simplex Type 2","code_information":[{"code":"4000032","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":266,"gross_charge":333,"discounted_cash":333,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":266}]}]},{"description":"Slctv Cath Plmt Ven Sys 1st Order Branch","code_information":[{"code":"8500273","type":"CDM"},{"code":"36011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":265,"maximum":924,"gross_charge":331,"discounted_cash":331,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Repair Inter S/a/t/e 2.5 Cm Or Less","code_information":[{"code":"8500107","type":"CDM"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":265,"maximum":924,"gross_charge":331,"discounted_cash":331,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Walking Boot Pneumatic And/or Vacuum","code_information":[{"code":"8401345","type":"CDM"},{"code":"450","type":"RC"},{"code":"L4361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":264,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Synthes 1.5 X 10mm Screws","code_information":[{"code":"2800564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":264,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Synthes 1.5 X 9mm Screws","code_information":[{"code":"2800565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":264,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Synthes 2x9mm Cortex Screw","code_information":[{"code":"2800586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":264,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Synthes 8x2mm Screw","code_information":[{"code":"2800624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":264,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Iv Infusion Hydration Initial 31 Min-1hr","code_information":[{"code":"8400382","type":"CDM"},{"code":"450","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":263,"gross_charge":329,"discounted_cash":329,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Iv Nfs Therapy Prophylaxis/dx Concur Nfs","code_information":[{"code":"8400387","type":"CDM"},{"code":"450","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":263,"gross_charge":329,"discounted_cash":329,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Shlder Fig 8 Abduct Restrain","code_information":[{"code":"8401337","type":"CDM"},{"code":"450","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":263,"maximum":263,"gross_charge":329,"discounted_cash":329,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Shlder Fig 8 Abduct Restrain","code_information":[{"code":"8401338","type":"CDM"},{"code":"450","type":"RC"},{"code":"L3660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":263,"maximum":263,"gross_charge":329,"discounted_cash":329,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Physical Therapy Evaluation","code_information":[{"code":"6100013","type":"CDM"},{"code":"424","type":"RC"},{"code":"97001","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":262,"gross_charge":328,"discounted_cash":328,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Carbamazepine Total","code_information":[{"code":"4000084","type":"CDM"},{"code":"450","type":"RC"},{"code":"80156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":262,"maximum":262,"gross_charge":327,"discounted_cash":327,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":262}]}]},{"description":"Bone Density Bone Mineral Content Study","code_information":[{"code":"5000032","type":"CDM"},{"code":"340","type":"RC"},{"code":"78350","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":262,"maximum":262,"gross_charge":327,"discounted_cash":327,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":262}]}]},{"description":"Iv Concurrent","code_information":[{"code":"3100012","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":262,"gross_charge":327,"discounted_cash":327,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Closed Tx Nasal Fracture W/o Manip","code_information":[{"code":"8500152","type":"CDM"},{"code":"21310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":262,"maximum":262,"gross_charge":327,"discounted_cash":327,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":262}]}]},{"description":"Fluoride","code_information":[{"code":"4000150","type":"CDM"},{"code":"300","type":"RC"},{"code":"82735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":261,"gross_charge":326,"discounted_cash":326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Special Stains","code_information":[{"code":"4000348","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":261,"gross_charge":326,"discounted_cash":326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Fluoride Serum/plasma","code_information":[{"code":"8400528","type":"CDM"},{"code":"300","type":"RC"},{"code":"82735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":261,"gross_charge":326,"discounted_cash":326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Lantus Insulin 100 Units/ml","code_information":[{"code":"3060925","type":"CDM"},{"code":"250","type":"RC"},{"code":"88222","type":"CPT","modifier":"33"}],"standard_charges":[{"setting":"outpatient","modifier_code":["33"],"minimum":261,"maximum":261,"gross_charge":326,"discounted_cash":326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":261}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Carcinoembryonic Antigen Cea","code_information":[{"code":"4000087","type":"CDM"},{"code":"300","type":"RC"},{"code":"82378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":261,"gross_charge":326,"discounted_cash":326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Cast Sup Sht Leg Splnt Fbrgl Adult","code_information":[{"code":"8401356","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":261,"gross_charge":326,"discounted_cash":326,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Simple Rpr S/n/s/g/t 7.6 To12.5cm","code_information":[{"code":"8500097","type":"CDM"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":924,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Removal Fb Intranasal Office Procedure","code_information":[{"code":"8500257","type":"CDM"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":260,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Synthes 20mm Cortical Screw 10mm","code_information":[{"code":"2800584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":260,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Iv Infusion Subsequent","code_information":[{"code":"3100006","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":260,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Electrocardiogram, routine, with interpretation and report","code_information":[{"code":"4200009","type":"CDM"},{"code":"730","type":"RC"},{"code":"93000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Electrocardiogram, routine, with interpretation and report","code_information":[{"code":"8400360","type":"CDM"},{"code":"730","type":"RC"},{"code":"93000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Procainamide 500mg/ml 2ml","code_information":[{"code":"3000248","type":"CDM"},{"code":"636","type":"RC"},{"code":"40919","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":259,"maximum":259,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":259}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Resp Nebulizer Tx","code_information":[{"code":"6400005","type":"CDM"},{"code":"460","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":259,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":200}]}]},{"description":"Pressurized/nonpressurized Inhalation Tx","code_information":[{"code":"8400377","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":259,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Injection Subc Musc","code_information":[{"code":"3100001","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":259,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Single Vaccine","code_information":[{"code":"3100010","type":"CDM"},{"code":"260","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":259,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Rpr Lac 2.5 Cm/< Flr Mth&/ant 2-3rd Tng","code_information":[{"code":"8500285","type":"CDM"},{"code":"41250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":1058,"gross_charge":323,"discounted_cash":323,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Complement Total Hemolytic Ch51","code_information":[{"code":"4000096","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":258,"gross_charge":323,"discounted_cash":323,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Antib Htlv Or Hiv Antib Confirm Test","code_information":[{"code":"4000036","type":"CDM"},{"code":"300","type":"RC"},{"code":"86689","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":258,"gross_charge":323,"discounted_cash":323,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Inf Agent Det Herpes Simplex Virus","code_information":[{"code":"4000234","type":"CDM"},{"code":"300","type":"RC"},{"code":"87530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":258,"gross_charge":322,"discounted_cash":322,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Iadna Herpes Somplx Virus Quantificaion","code_information":[{"code":"8400762","type":"CDM"},{"code":"300","type":"RC"},{"code":"87530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":258,"gross_charge":322,"discounted_cash":322,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Antib Epsteinbarr Virus Early Antigen","code_information":[{"code":"4000026","type":"CDM"},{"code":"300","type":"RC"},{"code":"86663","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":258,"gross_charge":322,"discounted_cash":322,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Antib Epsteinbarr Virus Viral Capsid","code_information":[{"code":"4000028","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":258,"gross_charge":322,"discounted_cash":322,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Antb Epstein-barr Eb Virus Early Ag Ea","code_information":[{"code":"8400661","type":"CDM"},{"code":"300","type":"RC"},{"code":"86663","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":258,"gross_charge":322,"discounted_cash":322,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Epstein-barr Capsid Vca","code_information":[{"code":"8400663","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":258,"gross_charge":322,"discounted_cash":322,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Place Needle In Vein","code_information":[{"code":"1000180","type":"CDM"},{"code":"450","type":"RC"},{"code":"36000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":257,"maximum":257,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":257}]}]},{"description":"Intro Ndl/intracath Vein","code_information":[{"code":"8400272","type":"CDM"},{"code":"450","type":"RC"},{"code":"36000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":257,"maximum":257,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":257}]}]},{"description":"Rem Fb Ext Eye Conjunctival Superficial","code_information":[{"code":"8400334","type":"CDM"},{"code":"450","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":257,"maximum":257,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":257}]}]},{"description":"3.5 Cortex Screw Slf Tapping 30 Mm","code_information":[{"code":"2800008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"3.5mm Cortex Screw 45mm","code_information":[{"code":"2800011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"3.5mm Cortex Screw 55mm","code_information":[{"code":"2800012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"3.5mm Cortex Screw 60mm","code_information":[{"code":"2800013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Synthes 3.5 Cortex Screw 12mm","code_information":[{"code":"2800588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Synthes 3.5 Cortex Screw 16","code_information":[{"code":"2800590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Synthes 3.5 Cortex Screw 18","code_information":[{"code":"2800591","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Synthes 3.5 Cortex Screw 20mm","code_information":[{"code":"2800592","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Synthes 3.5 Cortex Screw 28","code_information":[{"code":"2800594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Synthes 3.5 Cortex Screw 36mm","code_information":[{"code":"2800595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Synthes 3.5 X 24mm Cortex Screw","code_information":[{"code":"2800600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Synthes 3.5mm Cortex Screw Self-tapping","code_information":[{"code":"2800602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"Needle 1-2 Musc","code_information":[{"code":"6100073","type":"CDM"},{"code":"424","type":"RC"},{"code":"20560","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Needle 1-2 Musc","code_information":[{"code":"6100074","type":"CDM"},{"code":"424","type":"RC"},{"code":"20560","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":256,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Gonadotropin Follicle Stimulating Hormon","code_information":[{"code":"4000169","type":"CDM"},{"code":"300","type":"RC"},{"code":"83001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":255,"gross_charge":319,"discounted_cash":319,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Path Consul During Cytologic Exam","code_information":[{"code":"4000309","type":"CDM"},{"code":"310","type":"RC"},{"code":"88334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":255,"gross_charge":319,"discounted_cash":319,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Path Consul During Cytologic Exam","code_information":[{"code":"4000310","type":"CDM"},{"code":"310","type":"RC"},{"code":"88333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":255,"gross_charge":319,"discounted_cash":319,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Antibody West Nile Virus Igm","code_information":[{"code":"4000053","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":255,"gross_charge":319,"discounted_cash":319,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Gonadotropin Luteinizing Hormone Lh","code_information":[{"code":"4000170","type":"CDM"},{"code":"300","type":"RC"},{"code":"83002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":255,"gross_charge":319,"discounted_cash":319,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Phlebotomy","code_information":[{"code":"1000193","type":"CDM"},{"code":"450","type":"RC"},{"code":"99195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":254,"maximum":254,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254}]}]},{"description":"Uric Acid Blood","code_information":[{"code":"4000382","type":"CDM"},{"code":"300","type":"RC"},{"code":"84550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":254,"maximum":254,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"4000327","type":"CDM"},{"code":"301","type":"RC"},{"code":"84154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":253,"maximum":253,"gross_charge":316,"discounted_cash":316,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":253}]}]},{"description":"Debridement/high Press Waterjet W/wo Sct","code_information":[{"code":"8400396","type":"CDM"},{"code":"420","type":"RC"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":924,"gross_charge":315,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Iadna Herpes Smplx Virus Dir Prb","code_information":[{"code":"8400760","type":"CDM"},{"code":"300","type":"RC"},{"code":"87528","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":252,"maximum":252,"gross_charge":315,"discounted_cash":315,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":252}]}]},{"description":"Strapping Hand/finger","code_information":[{"code":"8400246","type":"CDM"},{"code":"450","type":"RC"},{"code":"29280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":251,"maximum":251,"gross_charge":314,"discounted_cash":314,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":251}]}]},{"description":"Pulse Ox For O2 Sat During Exercise","code_information":[{"code":"6400003","type":"CDM"},{"code":"450","type":"RC"},{"code":"94761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":409,"gross_charge":312,"discounted_cash":312,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":409}]}]},{"description":"N-invas Ear/pls Ox F/o2 Sat Mlt Deters","code_information":[{"code":"8400381","type":"CDM"},{"code":"922","type":"RC"},{"code":"94761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":409,"gross_charge":312,"discounted_cash":312,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":409}]}]},{"description":"Group Therapeutic Procedures","code_information":[{"code":"6100022","type":"CDM"},{"code":"420","type":"RC"},{"code":"97150","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":250,"gross_charge":312,"discounted_cash":312,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Group Pt Therapy","code_information":[{"code":"6100059","type":"CDM"},{"code":"424","type":"RC"},{"code":"97150","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":250,"gross_charge":312,"discounted_cash":312,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Group Pt Therapy","code_information":[{"code":"6100060","type":"CDM"},{"code":"424","type":"RC"},{"code":"97150","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":225,"maximum":250,"gross_charge":312,"discounted_cash":312,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Inf Agent Antigen C Diff","code_information":[{"code":"4000197","type":"CDM"},{"code":"300","type":"RC"},{"code":"87324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":249,"gross_charge":311,"discounted_cash":311,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"Iaad Eia Clostridium Difficile Toxin","code_information":[{"code":"8400735","type":"CDM"},{"code":"300","type":"RC"},{"code":"87324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":249,"gross_charge":311,"discounted_cash":311,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"Chromatography Quantitative Column","code_information":[{"code":"4000091","type":"CDM"},{"code":"300","type":"RC"},{"code":"82491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":248,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248}]}]},{"description":"Remove Intrauterine Device","code_information":[{"code":"8500314","type":"CDM"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":924,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248}]}]},{"description":"Creatine Kinase Ck Cpk Total","code_information":[{"code":"4000106","type":"CDM"},{"code":"300","type":"RC"},{"code":"82550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":248,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248}]}]},{"description":"Antibody Identification Leukocyte Antib","code_information":[{"code":"4000016","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":248,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248}]}]},{"description":"Antib Protozoa Not Elsewhere Specified","code_information":[{"code":"4000042","type":"CDM"},{"code":"300","type":"RC"},{"code":"86753","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":248,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248}]}]},{"description":"Antibody Rubeola","code_information":[{"code":"4000047","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":248,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248}]}]},{"description":"Neg Press Wound Tx < 50 Cm","code_information":[{"code":"6100020","type":"CDM"},{"code":"420","type":"RC"},{"code":"97605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":246,"gross_charge":308,"discounted_cash":308,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Blood Typing Abo","code_information":[{"code":"4000255","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":246,"gross_charge":308,"discounted_cash":308,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Inf Agent Antigen  Strep A (Send Out)","code_information":[{"code":"4000206","type":"CDM"},{"code":"300","type":"RC"},{"code":"87430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":246,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Iaad Eia Streptococcus Group A","code_information":[{"code":"8400746","type":"CDM"},{"code":"300","type":"RC"},{"code":"87430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":246,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Rem Corneal Epithelium W/wo Chemocauteri","code_information":[{"code":"8500339","type":"CDM"},{"code":"65435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":924,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Iv Infusion Hydration Each Additional Hr","code_information":[{"code":"8400383","type":"CDM"},{"code":"450","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":245,"gross_charge":306,"discounted_cash":306,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Hfo Wo/joints","code_information":[{"code":"8401342","type":"CDM"},{"code":"450","type":"RC"},{"code":"L3924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":245,"maximum":245,"gross_charge":306,"discounted_cash":306,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Clofaraline Injection","code_information":[{"code":"8401096","type":"CDM"},{"code":"450","type":"RC"},{"code":"J9027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":244,"maximum":244,"gross_charge":305,"discounted_cash":305,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":244}]}]},{"description":"Iv Therapy Each Addl Hour","code_information":[{"code":"8400385","type":"CDM"},{"code":"450","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":244,"gross_charge":305,"discounted_cash":305,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Infectious Agent Antigen Detection Hiv2","code_information":[{"code":"4000202","type":"CDM"},{"code":"300","type":"RC"},{"code":"87390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":242,"maximum":242,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242}]}]},{"description":"Catheterization Bladder","code_information":[{"code":"8400303","type":"CDM"},{"code":"450","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":242,"maximum":924,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242}]}]},{"description":"Bloxiverz 1mg/ml 10ml","code_information":[{"code":"3000033","type":"CDM"},{"code":"636","type":"RC"},{"code":"76014000310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":242,"maximum":242,"gross_charge":302,"discounted_cash":302,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Engerix-b (Hepatits B Vaccine)","code_information":[{"code":"3000085","type":"CDM"},{"code":"636","type":"RC"},{"code":"58160082111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":242,"maximum":242,"gross_charge":302,"discounted_cash":302,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Strapping Of Hip","code_information":[{"code":"8400249","type":"CDM"},{"code":"450","type":"RC"},{"code":"29520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":241,"gross_charge":301,"discounted_cash":301,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Inf Agnt Detect Na Herpes Simplex Virus","code_information":[{"code":"8400761","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":241,"gross_charge":301,"discounted_cash":301,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Culture Bacterial Aerobic","code_information":[{"code":"4000264","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":241,"gross_charge":301,"discounted_cash":301,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Thrombin 5,000 Units W/dil","code_information":[{"code":"3000299","type":"CDM"},{"code":"636","type":"RC"},{"code":"6079321505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":241,"maximum":241,"gross_charge":301,"discounted_cash":301,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":241}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Pulm Stress Test Simple Eg 6minute Walk","code_information":[{"code":"4200015","type":"CDM"},{"code":"410","type":"RC"},{"code":"94620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":240,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Control Of Nosebleed","code_information":[{"code":"8400260","type":"CDM"},{"code":"450","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":924,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Pulmonary Stress Test","code_information":[{"code":"8400375","type":"CDM"},{"code":"921","type":"RC"},{"code":"94620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":1060,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Vancomycin","code_information":[{"code":"8400469","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":240,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Vancomycin Hcl Injection 500mg","code_information":[{"code":"8400958","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":240,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Vancomycin 1gm Vl","code_information":[{"code":"3000309","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323028420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":240,"maximum":240,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Antib Epsteinbarr Virus Nuclear Antigen","code_information":[{"code":"4000027","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":240,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Epstein Barr Nuclear Antigen","code_information":[{"code":"8400662","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":240,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Endocrin Type 2 Diabetes Biochem Assay","code_information":[{"code":"4000138","type":"CDM"},{"code":"300","type":"RC"},{"code":"81506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":240,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Hepatitis B Surface Antibody Hbsab","code_information":[{"code":"4000179","type":"CDM"},{"code":"300","type":"RC"},{"code":"86706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":239,"gross_charge":299,"discounted_cash":299,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Preputial Stretching","code_information":[{"code":"8500308","type":"CDM"},{"code":"54450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":924,"gross_charge":299,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Debridement Of Nail(s) By Any Method 1-5","code_information":[{"code":"8400087","type":"CDM"},{"code":"450","type":"RC"},{"code":"11720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":924,"gross_charge":298,"discounted_cash":298,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"Draw Blood Off Venous Device","code_information":[{"code":"2200550","type":"CDM"},{"code":"940","type":"RC"},{"code":"36591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":300,"gross_charge":298,"discounted_cash":298,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Folic Acid Rbc","code_information":[{"code":"4000151","type":"CDM"},{"code":"300","type":"RC"},{"code":"82747","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":238,"gross_charge":297,"discounted_cash":297,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"Bupivacaine/meloxicam (Zynrelef) 14ml","code_information":[{"code":"3061991","type":"CDM"},{"code":"250","type":"RC"},{"code":"47426030102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":236,"maximum":236,"gross_charge":295,"discounted_cash":295,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236}]}],"drug_information":{"unit":14,"type":"ML"}},{"description":"Rmvl Fb Xtrnl Eye Crnl W/slit Lamp","code_information":[{"code":"8500337","type":"CDM"},{"code":"65222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":235,"maximum":235,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Moderate Sedation Additional 15min> 5yrs","code_information":[{"code":"2600002","type":"CDM"},{"code":"370","type":"RC"},{"code":"99157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":235,"maximum":235,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Moderate Sedation Addit 15 Min 5yrs+","code_information":[{"code":"8400409","type":"CDM"},{"code":"370","type":"RC"},{"code":"99157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":235,"maximum":235,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Haloperidol","code_information":[{"code":"4000991","type":"CDM"},{"code":"300","type":"RC"},{"code":"80173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":234,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"Neostigmine 1mg/ml 10ml Vial","code_information":[{"code":"3000216","type":"CDM"},{"code":"636","type":"RC"},{"code":"70700017223","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":234,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Antib Borrelia Burgdorferi Lyme Disease","code_information":[{"code":"4000019","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":234,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"Smpl Repair S/n/s/g/t 2.6cm To 7.5cm","code_information":[{"code":"8500096","type":"CDM"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":234,"gross_charge":292,"discounted_cash":292,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"Laryngoscopy Indirect Diagnostic Spx","code_information":[{"code":"8400263","type":"CDM"},{"code":"450","type":"RC"},{"code":"31505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":234,"gross_charge":292,"discounted_cash":292,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"Amylase","code_information":[{"code":"4000012","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":234,"gross_charge":292,"discounted_cash":292,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"Triiodothyronine T3 Free","code_information":[{"code":"4000373","type":"CDM"},{"code":"300","type":"RC"},{"code":"84481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233,"maximum":233,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":233}]}]},{"description":"Screw 6.5*25mm Cancellous Low Profile","code_information":[{"code":"2811525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":231,"maximum":231,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Iv Push Subsequent","code_information":[{"code":"3100004","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":231,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Subcutaneous Infusion Ea Add Iv Push","code_information":[{"code":"8400393","type":"CDM"},{"code":"450","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":231,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Stryker Bone Screw 3.5x 30mm","code_information":[{"code":"2800468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":231,"maximum":231,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Strapping Ankle &/Foot","code_information":[{"code":"8400251","type":"CDM"},{"code":"450","type":"RC"},{"code":"29540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":230,"gross_charge":288,"discounted_cash":288,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Strapping Unna Boot","code_information":[{"code":"8400253","type":"CDM"},{"code":"450","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":300,"gross_charge":288,"discounted_cash":288,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Incision&drain Pilonidal Cyst Simple","code_information":[{"code":"8500070","type":"CDM"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":924,"gross_charge":287,"discounted_cash":287,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Visual Function Screening","code_information":[{"code":"8400410","type":"CDM"},{"code":"450","type":"RC"},{"code":"99172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":230,"gross_charge":287,"discounted_cash":287,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Closed Tx Tmj Dislocation Init/subseq","code_information":[{"code":"8500157","type":"CDM"},{"code":"21480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":924,"gross_charge":287,"discounted_cash":287,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Repair Tongue Laceration 1/3 Of Tongue","code_information":[{"code":"8500286","type":"CDM"},{"code":"41251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":1058,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229}]}]},{"description":"Established Pt Self Limited/minor","code_information":[{"code":"6100081","type":"CDM"},{"code":"424","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":229,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Established Pt Self Limited/minor","code_information":[{"code":"6100082","type":"CDM"},{"code":"424","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":229,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Thyroid Hormone T3 Or T4 Uptake","code_information":[{"code":"4000361","type":"CDM"},{"code":"300","type":"RC"},{"code":"84479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":229,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229}]}]},{"description":"Thyr Horm Uptk/thyr Horm Bndng Ratio","code_information":[{"code":"8400590","type":"CDM"},{"code":"300","type":"RC"},{"code":"84479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":229,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229}]}]},{"description":"X Ray Cephalogram Orthodontic","code_information":[{"code":"8401438","type":"CDM"},{"code":"329","type":"RC"},{"code":"70350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":226,"gross_charge":283,"discounted_cash":283,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"I&d Absc Pritonsillar","code_information":[{"code":"8500290","type":"CDM"},{"code":"42700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":924,"gross_charge":283,"discounted_cash":283,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"G6pc/glucose6phosphatase Cataly Subunit","code_information":[{"code":"4000153","type":"CDM"},{"code":"300","type":"RC"},{"code":"81250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":226,"gross_charge":283,"discounted_cash":283,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"Phenytoin Free","code_information":[{"code":"4000315","type":"CDM"},{"code":"300","type":"RC"},{"code":"80186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":226,"gross_charge":283,"discounted_cash":283,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"Glucose Blood By Glucose Monitoring","code_information":[{"code":"4000160","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":226,"gross_charge":283,"discounted_cash":283,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"Epinephrine 1 Mg/ml 30 Ml Vial","code_information":[{"code":"3000088","type":"CDM"},{"code":"636","type":"RC"},{"code":"42023010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":226,"maximum":226,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Antb Htlv/hiv Antb Confirmatory Tst","code_information":[{"code":"8400666","type":"CDM"},{"code":"300","type":"RC"},{"code":"86689","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":226,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"Iv Push Add","code_information":[{"code":"3100003","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":225,"gross_charge":281,"discounted_cash":281,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Cyanocobalamin B12","code_information":[{"code":"4000122","type":"CDM"},{"code":"300","type":"RC"},{"code":"82607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":225,"gross_charge":281,"discounted_cash":281,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":225}]}]},{"description":"Cortisol Total","code_information":[{"code":"4000098","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":224,"gross_charge":280,"discounted_cash":280,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"Synthes 1.25mm Threaded Guide 150mm","code_information":[{"code":"2800556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":224,"gross_charge":280,"discounted_cash":280,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"Desmopressin 4mcg/ml Amp","code_information":[{"code":"3000064","type":"CDM"},{"code":"636","type":"RC"},{"code":"69918089910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":223,"maximum":223,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Inj-unlist Thera Proph/dx Iv/ia Njx/nfs","code_information":[{"code":"8400394","type":"CDM"},{"code":"450","type":"RC"},{"code":"96379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":223,"maximum":223,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Dress/debrid P-thick Burn Large","code_information":[{"code":"8500135","type":"CDM"},{"code":"16030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":223,"maximum":1058,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Gonadotropin Chorionic Hcg Qualitative","code_information":[{"code":"4000168","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":223,"maximum":223,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Hcggonad Chornc Qual","code_information":[{"code":"8400603","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":223,"maximum":223,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Simple Repair S/n/s/g/t 2.5cm Or Less","code_information":[{"code":"8500095","type":"CDM"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":223,"maximum":924,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Albumin 25% 12.5gm/50ml","code_information":[{"code":"3000008","type":"CDM"},{"code":"636","type":"RC"},{"code":"44206025105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":222,"gross_charge":277,"discounted_cash":277,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Magnevist 5x10ml","code_information":[{"code":"3000179","type":"CDM"},{"code":"636","type":"RC"},{"code":"50149018815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":221,"maximum":221,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Amylase","code_information":[{"code":"8400494","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":221,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Triiodothyronine T3 Reverse","code_information":[{"code":"4000374","type":"CDM"},{"code":"300","type":"RC"},{"code":"84482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":220,"maximum":220,"gross_charge":275,"discounted_cash":275,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"Reverse T3","code_information":[{"code":"8400593","type":"CDM"},{"code":"300","type":"RC"},{"code":"84482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":220,"maximum":220,"gross_charge":275,"discounted_cash":275,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"Inj Tc99m Tetrofosmin","code_information":[{"code":"5000331","type":"CDM"},{"code":"340","type":"RC"},{"code":"A9502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":220,"maximum":220,"gross_charge":275,"discounted_cash":275,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"Aspirate/inj Ganglion Cyst","code_information":[{"code":"8500151","type":"CDM"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":219,"maximum":924,"gross_charge":274,"discounted_cash":274,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":219}]}]},{"description":"Gonadotropin Chorionic Hcg Quantitative","code_information":[{"code":"4000167","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":219,"maximum":219,"gross_charge":274,"discounted_cash":274,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":219}]}]},{"description":"Gonad Chornc Quan","code_information":[{"code":"8400602","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":219,"maximum":219,"gross_charge":274,"discounted_cash":274,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":219}]}]},{"description":"Moderate Sedation Initial 15 Min >5yrs","code_information":[{"code":"2600003","type":"CDM"},{"code":"370","type":"RC"},{"code":"99156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":218,"gross_charge":273,"discounted_cash":273,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"Moderate Sedation Initial 15 Min 5yrs+","code_information":[{"code":"8400408","type":"CDM"},{"code":"370","type":"RC"},{"code":"99156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":218,"gross_charge":273,"discounted_cash":273,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"Dipropylacetic Acid Valproic Acid","code_information":[{"code":"4000130","type":"CDM"},{"code":"300","type":"RC"},{"code":"80164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":218,"gross_charge":273,"discounted_cash":273,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"Dbrdmt Mstdc Cavity Smpl","code_information":[{"code":"8500348","type":"CDM"},{"code":"69220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":217,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":217}]}]},{"description":"Finger Splint Static","code_information":[{"code":"8401358","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":217,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":217}]}]},{"description":"Acetaminophen (Ofirmev) 1000mg/100ml Iv","code_information":[{"code":"3000222","type":"CDM"},{"code":"636","type":"RC"},{"code":"24201010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":215,"maximum":215,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"4000253","type":"CDM"},{"code":"301","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":214,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Triiodothyro9 T3 Fr","code_information":[{"code":"8400592","type":"CDM"},{"code":"300","type":"RC"},{"code":"84481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":214,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"8400608","type":"CDM"},{"code":"301","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":214,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Rmvl Fb Xtrnl Aud Canal Anes","code_information":[{"code":"8500345","type":"CDM"},{"code":"69205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":924,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Rmvl Impacted Cerumen Spx 1/bth Ears","code_information":[{"code":"8500347","type":"CDM"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":924,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Blood Count; Leukocyte (Wbc)","code_information":[{"code":"4000254","type":"CDM"},{"code":"300","type":"RC"},{"code":"85048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":214,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Creatine Kinase Ck Cpk Isoforms","code_information":[{"code":"4000105","type":"CDM"},{"code":"300","type":"RC"},{"code":"82554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":214,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Creatine Kinase Isoforms","code_information":[{"code":"8400520","type":"CDM"},{"code":"300","type":"RC"},{"code":"82554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":214,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Cast Sup Lng Arm Splint Fbrg Adult","code_information":[{"code":"8401348","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":214,"gross_charge":267,"discounted_cash":267,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Iv Psh Ad Drg Thr Prph/dx Njx Iv Psh Sb","code_information":[{"code":"8400392","type":"CDM"},{"code":"450","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":213,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Hepatitis C Antibody Confirmatory","code_information":[{"code":"4000182","type":"CDM"},{"code":"300","type":"RC"},{"code":"86804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":213,"maximum":213,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Meas Pst-vd Res Urine &/Or Bladdr Cap Us","code_information":[{"code":"8400306","type":"CDM"},{"code":"450","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":213,"maximum":213,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Culture Presumptive Pathogenic Organism","code_information":[{"code":"4000118","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":212,"gross_charge":265,"discounted_cash":265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Cul Prsmptv Pthgnc Organisms Scr","code_information":[{"code":"8400715","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":212,"gross_charge":265,"discounted_cash":265,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Observation Care Discharge Day Mgmnt","code_information":[{"code":"8500413","type":"CDM"},{"code":"99217","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":210,"gross_charge":262,"discounted_cash":262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210}]}]},{"description":"Pathology Consultation With Frozen Sect","code_information":[{"code":"4000311","type":"CDM"},{"code":"310","type":"RC"},{"code":"88332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":210,"gross_charge":262,"discounted_cash":262,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210}]}]},{"description":"Rhogam Injection","code_information":[{"code":"8400945","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":209,"maximum":209,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"Unattended Electrical Stimulation","code_information":[{"code":"6100053","type":"CDM"},{"code":"424","type":"RC"},{"code":"97014","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":209,"maximum":225,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Unattended Electrical Stimulation","code_information":[{"code":"6100054","type":"CDM"},{"code":"424","type":"RC"},{"code":"97014","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":209,"maximum":225,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Amputation Foot Transmetatarsal Add 1 M","code_information":[{"code":"2200043","type":"CDM"},{"code":"360","type":"RC"},{"code":"28805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Ant Vesicoure/urethropexy Smp Add 1 Min","code_information":[{"code":"2200069","type":"CDM"},{"code":"360","type":"RC"},{"code":"51840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Arthrodesis Ankle Open Add 15 Min","code_information":[{"code":"2200116","type":"CDM"},{"code":"360","type":"RC"},{"code":"27870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Fusion Of Foot Bones","code_information":[{"code":"2200147","type":"CDM"},{"code":"360","type":"RC"},{"code":"28730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Reconstruct Shoulder Joint","code_information":[{"code":"2200184","type":"CDM"},{"code":"360","type":"RC"},{"code":"23470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Arthroplasty Ipj Each Joint","code_information":[{"code":"2200188","type":"CDM"},{"code":"360","type":"RC"},{"code":"26535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Wrist Joints","code_information":[{"code":"2200192","type":"CDM"},{"code":"360","type":"RC"},{"code":"25447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Revise Knuckle With Implant","code_information":[{"code":"2200200","type":"CDM"},{"code":"360","type":"RC"},{"code":"26531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200203","type":"CDM"},{"code":"360","type":"RC"},{"code":"29888","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Shoulder Arthroscopy Dx","code_information":[{"code":"2200255","type":"CDM"},{"code":"360","type":"RC"},{"code":"29805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Arthroscopy Shldr/bicep Tenodesis","code_information":[{"code":"2200257","type":"CDM"},{"code":"360","type":"RC"},{"code":"29828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Arthroscopy Shldr Capsulorrhaphy","code_information":[{"code":"2200259","type":"CDM"},{"code":"360","type":"RC"},{"code":"29806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Shaving of shoulder bone using endoscope","code_information":[{"code":"2200265","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Shoulder Arthroscopy/surgery","code_information":[{"code":"2200267","type":"CDM"},{"code":"360","type":"RC"},{"code":"29824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Arthroscopy Shoulder Rep Slap Lesion","code_information":[{"code":"2200269","type":"CDM"},{"code":"360","type":"RC"},{"code":"29807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Arthroscopy Shldr W/rot Cuff Repair","code_information":[{"code":"2200277","type":"CDM"},{"code":"360","type":"RC"},{"code":"29827","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Revision Of Lower Eyelid","code_information":[{"code":"2200398","type":"CDM"},{"code":"360","type":"RC"},{"code":"15821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Blepharoplasty Upper Eyelid","code_information":[{"code":"2200400","type":"CDM"},{"code":"360","type":"RC"},{"code":"15822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Revision Of Upper Eyelid","code_information":[{"code":"2200402","type":"CDM"},{"code":"360","type":"RC"},{"code":"15823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Bunionectomy W/proximal Metarsal Osteoto","code_information":[{"code":"2200425","type":"CDM"},{"code":"360","type":"RC"},{"code":"28295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Removal Of Gallbladder","code_information":[{"code":"2200469","type":"CDM"},{"code":"360","type":"RC"},{"code":"47612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1868,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Cholecystectomy","code_information":[{"code":"2200471","type":"CDM"},{"code":"360","type":"RC"},{"code":"47600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Correction Hallux Valgus","code_information":[{"code":"2200610","type":"CDM"},{"code":"360","type":"RC"},{"code":"28299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Correction Hallux Valgus","code_information":[{"code":"2200614","type":"CDM"},{"code":"360","type":"RC"},{"code":"28292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Correction Hallux Valgus","code_information":[{"code":"2200616","type":"CDM"},{"code":"360","type":"RC"},{"code":"28297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Correction Hallux Valgus","code_information":[{"code":"2200618","type":"CDM"},{"code":"360","type":"RC"},{"code":"28296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Of Hammertoe","code_information":[{"code":"2200620","type":"CDM"},{"code":"360","type":"RC"},{"code":"28285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200630","type":"CDM"},{"code":"360","type":"RC"},{"code":"52320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200678","type":"CDM"},{"code":"360","type":"RC"},{"code":"52332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Cystourethroscopy W/urethral Stnt","code_information":[{"code":"2200680","type":"CDM"},{"code":"360","type":"RC"},{"code":"52282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Destruction Penis Lesion(s)","code_information":[{"code":"2200794","type":"CDM"},{"code":"360","type":"RC"},{"code":"54065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":924,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Destroy Vulva Lesions Sim","code_information":[{"code":"2200804","type":"CDM"},{"code":"360","type":"RC"},{"code":"56501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":924,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Endovascular Repair The Iliac Artery","code_information":[{"code":"2200885","type":"CDM"},{"code":"360","type":"RC"},{"code":"34718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Removal Of Intranasal Lesion","code_information":[{"code":"2201057","type":"CDM"},{"code":"360","type":"RC"},{"code":"30117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Removal of cataract with insertion of lens","code_information":[{"code":"2201255","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"66984","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Xcapsl Ctrc Rmvl Cplx Wo Ecp","code_information":[{"code":"2201257","type":"CDM"},{"code":"360","type":"RC"},{"code":"66982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Removal Of Stomach Partial","code_information":[{"code":"2201300","type":"CDM"},{"code":"360","type":"RC"},{"code":"43632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Removal Of Stomach Partial","code_information":[{"code":"2201302","type":"CDM"},{"code":"360","type":"RC"},{"code":"43633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Removal Of Stomach","code_information":[{"code":"2201304","type":"CDM"},{"code":"360","type":"RC"},{"code":"43621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Mesh Implant Incis/ventral Hernia Rep","code_information":[{"code":"2201369","type":"CDM"},{"code":"360","type":"RC"},{"code":"49568","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Implant Spine Infusion Pump","code_information":[{"code":"2201371","type":"CDM"},{"code":"360","type":"RC"},{"code":"62362","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Insert Self-contd Prosthesis","code_information":[{"code":"2201557","type":"CDM"},{"code":"360","type":"RC"},{"code":"54401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Insrt/redo Pn/gastr Stimul","code_information":[{"code":"2201576","type":"CDM"},{"code":"360","type":"RC"},{"code":"64590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Insrt/redo Spine N Generator","code_information":[{"code":"2201578","type":"CDM"},{"code":"360","type":"RC"},{"code":"63685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Laparoscopy Appendectomy","code_information":[{"code":"2201639","type":"CDM"},{"code":"360","type":"RC"},{"code":"44970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Sleeve Gastrectomy","code_information":[{"code":"2201647","type":"CDM"},{"code":"360","type":"RC"},{"code":"43775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Place Gastr Adj Device","code_information":[{"code":"2201649","type":"CDM"},{"code":"360","type":"RC"},{"code":"43770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Replace Gastr Adj Device","code_information":[{"code":"2201651","type":"CDM"},{"code":"360","type":"RC"},{"code":"43773","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Rmvl Gastr Adj All Parts","code_information":[{"code":"2201653","type":"CDM"},{"code":"360","type":"RC"},{"code":"43774","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Revise Gastr Adj Device","code_information":[{"code":"2201655","type":"CDM"},{"code":"360","type":"RC"},{"code":"43771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Inc Hernia Repair","code_information":[{"code":"2201667","type":"CDM"},{"code":"360","type":"RC"},{"code":"49654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Vent/abd Hern Proc Comp","code_information":[{"code":"2201669","type":"CDM"},{"code":"360","type":"RC"},{"code":"49653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Laparo-asst Vag Hysterectomy","code_information":[{"code":"2201691","type":"CDM"},{"code":"360","type":"RC"},{"code":"58550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1868,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Laparo-vag Hyst Complex","code_information":[{"code":"2201693","type":"CDM"},{"code":"360","type":"RC"},{"code":"58553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Laparo-vag Hyst W/t/o Compl","code_information":[{"code":"2201695","type":"CDM"},{"code":"360","type":"RC"},{"code":"58554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Ing Hernia Repair Init","code_information":[{"code":"2201709","type":"CDM"},{"code":"360","type":"RC"},{"code":"49650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Lap Ing Hernia Repair Recur","code_information":[{"code":"2201711","type":"CDM"},{"code":"360","type":"RC"},{"code":"49651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Laser Surgery Of Prostate","code_information":[{"code":"2201748","type":"CDM"},{"code":"360","type":"RC"},{"code":"52647","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Laser Surgery Of Prostate","code_information":[{"code":"2201750","type":"CDM"},{"code":"360","type":"RC"},{"code":"52648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Remove Bladder Stone Smpl","code_information":[{"code":"2201790","type":"CDM"},{"code":"360","type":"RC"},{"code":"52317","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":924,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Nsl/sins Ndsc Total","code_information":[{"code":"2201861","type":"CDM"},{"code":"360","type":"RC"},{"code":"31253","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Nsl/sins Ndsc Tot W/sphendt","code_information":[{"code":"2201863","type":"CDM"},{"code":"360","type":"RC"},{"code":"31257","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Nsl/sins Ndsc Sphn Tiss Rmvl","code_information":[{"code":"2201865","type":"CDM"},{"code":"360","type":"RC"},{"code":"31259","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Nsl/sins Ndsc Surg Frnt&sphn","code_information":[{"code":"2201867","type":"CDM"},{"code":"360","type":"RC"},{"code":"31298","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Nsl/sins Ndsc Surg Frnt Sins","code_information":[{"code":"2201892","type":"CDM"},{"code":"360","type":"RC"},{"code":"31296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Nsl/sins Ndsc Surg Sphn Sins","code_information":[{"code":"2201896","type":"CDM"},{"code":"360","type":"RC"},{"code":"31297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treatment Of Ankle Fracture","code_information":[{"code":"2201952","type":"CDM"},{"code":"360","type":"RC"},{"code":"27814","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treatment Of Ankle Fracture","code_information":[{"code":"2201964","type":"CDM"},{"code":"360","type":"RC"},{"code":"27792","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treatment Of Thigh Fracture","code_information":[{"code":"2201980","type":"CDM"},{"code":"360","type":"RC"},{"code":"27507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Big Toe Fracture","code_information":[{"code":"2201990","type":"CDM"},{"code":"360","type":"RC"},{"code":"28505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Toe Fracture","code_information":[{"code":"2201992","type":"CDM"},{"code":"360","type":"RC"},{"code":"28525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"2201994","type":"CDM"},{"code":"360","type":"RC"},{"code":"23630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"2202002","type":"CDM"},{"code":"360","type":"RC"},{"code":"24515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Of Toe Dislocation","code_information":[{"code":"2202008","type":"CDM"},{"code":"360","type":"RC"},{"code":"28675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Optx Medial Ankle Fx","code_information":[{"code":"2202014","type":"CDM"},{"code":"360","type":"RC"},{"code":"27766","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Metacarpal Fracture","code_information":[{"code":"2202016","type":"CDM"},{"code":"360","type":"RC"},{"code":"26615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Metatarsal Fracture","code_information":[{"code":"2202018","type":"CDM"},{"code":"360","type":"RC"},{"code":"28485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Toe Dislocation","code_information":[{"code":"2202020","type":"CDM"},{"code":"360","type":"RC"},{"code":"28645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"2202029","type":"CDM"},{"code":"360","type":"RC"},{"code":"26735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"2202032","type":"CDM"},{"code":"360","type":"RC"},{"code":"23615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Fracture Of Radius","code_information":[{"code":"2202042","type":"CDM"},{"code":"360","type":"RC"},{"code":"25515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Sesamoid Bone Fracture","code_information":[{"code":"2202046","type":"CDM"},{"code":"360","type":"RC"},{"code":"28531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treatment Of Tibia Fracture","code_information":[{"code":"2202058","type":"CDM"},{"code":"360","type":"RC"},{"code":"27758","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treatment Of Ankle Fracture","code_information":[{"code":"2202060","type":"CDM"},{"code":"360","type":"RC"},{"code":"27823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Revise Eye Socket Implant","code_information":[{"code":"2202074","type":"CDM"},{"code":"360","type":"RC"},{"code":"67560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Osteotomy Spine Post Approach 1 Vertebra","code_information":[{"code":"2202096","type":"CDM"},{"code":"360","type":"RC"},{"code":"22216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":924,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Incis 1 Vertebral Seg Thorac","code_information":[{"code":"2202099","type":"CDM"},{"code":"360","type":"RC"},{"code":"22212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Osteotomy Spine Post Approach 3 Column","code_information":[{"code":"2202101","type":"CDM"},{"code":"360","type":"RC"},{"code":"22208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":924,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Incis Spine 3 Column Lumbar","code_information":[{"code":"2202103","type":"CDM"},{"code":"360","type":"RC"},{"code":"22207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Incis Spine 3 Column Thorac","code_information":[{"code":"2202105","type":"CDM"},{"code":"360","type":"RC"},{"code":"22206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Incision Of Metatarsal","code_information":[{"code":"2202117","type":"CDM"},{"code":"360","type":"RC"},{"code":"28306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Incision Of Metatarsal","code_information":[{"code":"2202119","type":"CDM"},{"code":"360","type":"RC"},{"code":"28308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Incision Of Heel Bone","code_information":[{"code":"2202121","type":"CDM"},{"code":"360","type":"RC"},{"code":"28300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"2202201","type":"CDM"},{"code":"360","type":"RC"},{"code":"26727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Remove Spine Fixation Device","code_information":[{"code":"2202383","type":"CDM"},{"code":"360","type":"RC"},{"code":"22852","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1868,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Remove Spine Infusion Device","code_information":[{"code":"2202399","type":"CDM"},{"code":"360","type":"RC"},{"code":"62365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Removal Tunneled Cv Cath","code_information":[{"code":"2202406","type":"CDM"},{"code":"360","type":"RC"},{"code":"36590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":924,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Revise/remove Sling Repair","code_information":[{"code":"2202412","type":"CDM"},{"code":"360","type":"RC"},{"code":"57287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repr Elbow Lat Ligmnt W/tiss","code_information":[{"code":"2202434","type":"CDM"},{"code":"360","type":"RC"},{"code":"24343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Spinal Fluid Leakage","code_information":[{"code":"2202456","type":"CDM"},{"code":"360","type":"RC"},{"code":"63709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Nasal Stenosis","code_information":[{"code":"2202476","type":"CDM"},{"code":"360","type":"RC"},{"code":"30465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Rotator Cuff Chronic","code_information":[{"code":"2202486","type":"CDM"},{"code":"360","type":"RC"},{"code":"23412","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Finger/hand Tendon","code_information":[{"code":"2202492","type":"CDM"},{"code":"360","type":"RC"},{"code":"26356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair/graft Hand Tendon","code_information":[{"code":"2202494","type":"CDM"},{"code":"360","type":"RC"},{"code":"26358","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Lower Leg Tendons","code_information":[{"code":"2202532","type":"CDM"},{"code":"360","type":"RC"},{"code":"27676","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Lower Leg Tendons","code_information":[{"code":"2202534","type":"CDM"},{"code":"360","type":"RC"},{"code":"27675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Of Ankle Ligament","code_information":[{"code":"2202558","type":"CDM"},{"code":"360","type":"RC"},{"code":"27695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Achilles Tendon","code_information":[{"code":"2202560","type":"CDM"},{"code":"360","type":"RC"},{"code":"27650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair/graft Achilles Tendon","code_information":[{"code":"2202562","type":"CDM"},{"code":"360","type":"RC"},{"code":"27652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Resect/excise Lesion Skull","code_information":[{"code":"2202591","type":"CDM"},{"code":"360","type":"RC"},{"code":"61615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Revise/replace Knee Joint","code_information":[{"code":"2202615","type":"CDM"},{"code":"360","type":"RC"},{"code":"27486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1868,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Removal Of Ovary/tube(s)","code_information":[{"code":"2202641","type":"CDM"},{"code":"360","type":"RC"},{"code":"58720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Of Nasal Septum","code_information":[{"code":"2202647","type":"CDM"},{"code":"360","type":"RC"},{"code":"30520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Bladder Defect","code_information":[{"code":"2202669","type":"CDM"},{"code":"360","type":"RC"},{"code":"57288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Skin Splt Grft Trnk/arm/leg","code_information":[{"code":"2202681","type":"CDM"},{"code":"360","type":"RC"},{"code":"15100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Partial Hysterectomy","code_information":[{"code":"2202695","type":"CDM"},{"code":"360","type":"RC"},{"code":"58180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Excise Wrist Tendon Sheath","code_information":[{"code":"2202729","type":"CDM"},{"code":"360","type":"RC"},{"code":"25118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Tendon Excision Palm/finger","code_information":[{"code":"2202733","type":"CDM"},{"code":"360","type":"RC"},{"code":"26145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Talectomy Astragalectomy","code_information":[{"code":"2202735","type":"CDM"},{"code":"360","type":"RC"},{"code":"28130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Repair Elbow Deb/attch Open","code_information":[{"code":"2202760","type":"CDM"},{"code":"360","type":"RC"},{"code":"24359","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1232,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Total Hysterectomy","code_information":[{"code":"2202809","type":"CDM"},{"code":"360","type":"RC"},{"code":"58150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":2196,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Prostatectomy (Turp)","code_information":[{"code":"2202839","type":"CDM"},{"code":"360","type":"RC"},{"code":"52601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1508,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Vaginal Hysterectomy","code_information":[{"code":"2202952","type":"CDM"},{"code":"360","type":"RC"},{"code":"58260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Vag Hyst Complex","code_information":[{"code":"2202956","type":"CDM"},{"code":"360","type":"RC"},{"code":"58290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1665,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Or Level 4 Each Add'l Min","code_information":[{"code":"2202985","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202985","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Abdominal Paracentesis W/ Guidance","code_information":[{"code":"2202997","type":"CDM"},{"code":"360","type":"RC"},{"code":"49083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":1058,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Stryker 1.2 X 4mm Screw","code_information":[{"code":"2800419","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Stryker 1.2 X 5mm Screw","code_information":[{"code":"2800420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Radiologic Examination, Temporomandibula","code_information":[{"code":"5210002","type":"CDM"},{"code":"320","type":"RC"},{"code":"70328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":208,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Clsd Tx Fract Grt Toe Phlnx/phlng Wo/mnp","code_information":[{"code":"8500231","type":"CDM"},{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":924,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Inf Agent Detection By Dna Or Rna C Diff","code_information":[{"code":"4000225","type":"CDM"},{"code":"300","type":"RC"},{"code":"87493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":207,"maximum":207,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"Inf Agent Det Nuc Acid Clostridium Amp","code_information":[{"code":"8400753","type":"CDM"},{"code":"300","type":"RC"},{"code":"87493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":207,"maximum":207,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"Monkey Pox","code_information":[{"code":"4000992","type":"CDM"},{"code":"300","type":"RC"},{"code":"87593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":206,"maximum":206,"gross_charge":257,"discounted_cash":257,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":206}]}]},{"description":"Inf Agent Antigen Det By Enz Immunoassay","code_information":[{"code":"4000196","type":"CDM"},{"code":"300","type":"RC"},{"code":"87450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":205,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":205}]}]},{"description":"Ag Detect Nos Eia Single","code_information":[{"code":"8400747","type":"CDM"},{"code":"300","type":"RC"},{"code":"87450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":205,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":205}]}]},{"description":"Removal Of Foreign Body From Pharynx","code_information":[{"code":"8500291","type":"CDM"},{"code":"42809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":924,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":205}]}]},{"description":"Ppd Aplisol Vl","code_information":[{"code":"8401008","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":204,"maximum":204,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":204}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Immunoassay Analyte Other Than Inf Agent","code_information":[{"code":"4000185","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204,"maximum":204,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Thiamine Vitamin B-1","code_information":[{"code":"4000398","type":"CDM"},{"code":"300","type":"RC"},{"code":"84425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204,"maximum":204,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Immunoassay For Tumor Antigen","code_information":[{"code":"4000188","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":203,"gross_charge":254,"discounted_cash":254,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Protonixpantroprazole 40mg","code_information":[{"code":"8401123","type":"CDM"},{"code":"450","type":"RC"},{"code":"S0164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Cerv Col Thermplas Foam 2 Pi","code_information":[{"code":"8401330","type":"CDM"},{"code":"450","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Cult Bact Quant Colony Count Urine","code_information":[{"code":"4000267","type":"CDM"},{"code":"300","type":"RC"},{"code":"87086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Cul Bact Quan Colony Cnt Urine","code_information":[{"code":"8400716","type":"CDM"},{"code":"300","type":"RC"},{"code":"87086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Thrombolytic Therapy Stroke","code_information":[{"code":"8500279","type":"CDM"},{"code":"37195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Change Of Gastromy Tube","code_information":[{"code":"8500294","type":"CDM"},{"code":"43760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Folic Acid Serum","code_information":[{"code":"4000152","type":"CDM"},{"code":"450","type":"RC"},{"code":"82746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Platelet Aggregation In Vitro Each Agent","code_information":[{"code":"4000320","type":"CDM"},{"code":"300","type":"RC"},{"code":"85576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Smear Primary Source For Parasite","code_information":[{"code":"4000344","type":"CDM"},{"code":"300","type":"RC"},{"code":"87207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":202,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Cyanocobalamin Unsaturated Binding Cap","code_information":[{"code":"8400523","type":"CDM"},{"code":"300","type":"RC"},{"code":"82608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Ammonia","code_information":[{"code":"4000011","type":"CDM"},{"code":"300","type":"RC"},{"code":"82140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Cast Hand&lower Forearm Gauntlet","code_information":[{"code":"8400238","type":"CDM"},{"code":"450","type":"RC"},{"code":"29085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Long Leg Splint Thigh Ankle/toes","code_information":[{"code":"8400247","type":"CDM"},{"code":"450","type":"RC"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Short Leg Splint Calf Foot","code_information":[{"code":"8400248","type":"CDM"},{"code":"450","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":300,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Cul Bact Xcpt Urine Bld/stl Aerc Isol","code_information":[{"code":"8400710","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Parametrics Set Scre","code_information":[{"code":"2800782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Covid Lab Code Infectious Agent","code_information":[{"code":"4000099","type":"CDM"},{"code":"300","type":"RC"},{"code":"U0003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Inf Agent Detection By Dna/rna Sarscov3","code_information":[{"code":"4000242","type":"CDM"},{"code":"300","type":"RC"},{"code":"87636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Triglycerides","code_information":[{"code":"4000372","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Nlisted Therapeutic Procedure","code_information":[{"code":"6100057","type":"CDM"},{"code":"424","type":"RC"},{"code":"97139","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":200,"maximum":225,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Nlisted Therapeutic Procedure","code_information":[{"code":"6100058","type":"CDM"},{"code":"424","type":"RC"},{"code":"97139","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":200,"maximum":225,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Infect Dis Path S22 Targt Inc Sars-cov-2","code_information":[{"code":"8400446","type":"CDM"},{"code":"300","type":"RC"},{"code":"0202U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Inf Agent Detect Na Sars-cov-2+flu","code_information":[{"code":"8400770","type":"CDM"},{"code":"300","type":"RC"},{"code":"87636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Inf Agent Detect Na Covid 19/flu/resp Sy","code_information":[{"code":"8400771","type":"CDM"},{"code":"300","type":"RC"},{"code":"87637","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Inf Agt Ant Dct Im W/drct Optc Obs Cov19","code_information":[{"code":"8400781","type":"CDM"},{"code":"300","type":"RC"},{"code":"87811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Inf Agnt Dtct Na Sarscov2 Amp Probe Tech","code_information":[{"code":"8400801","type":"CDM"},{"code":"450","type":"RC"},{"code":"U0003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"2019 Ncovsars Any Tech High Throughput","code_information":[{"code":"8400802","type":"CDM"},{"code":"450","type":"RC"},{"code":"U0004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Emer Dept Self Limited/minor","code_information":[{"code":"8500420","type":"CDM"},{"code":"99281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Rem Fb Of Ear Xtrnl Aud Canal W/o Anes","code_information":[{"code":"8500344","type":"CDM"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":200,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Mmr Virus Vaccine Live Subq","code_information":[{"code":"8400833","type":"CDM"},{"code":"250","type":"RC"},{"code":"90707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":199,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dtp-hib Im Use","code_information":[{"code":"8400837","type":"CDM"},{"code":"250","type":"RC"},{"code":"90723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":199,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rmvl Fb Xtrnl Eye Crnl W/o Slit Lamp","code_information":[{"code":"8500336","type":"CDM"},{"code":"65220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":199,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Antibody Screen Rbc Each Serum Technique","code_information":[{"code":"4000017","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":199,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Antb Scr Rbc Ea Serum Tq","code_information":[{"code":"8400699","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":199,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Gonadotropin Chorionic Hcg Free Beta Chn","code_information":[{"code":"4000166","type":"CDM"},{"code":"300","type":"RC"},{"code":"84704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":199,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Gonadotropin Chorionic","code_information":[{"code":"8400604","type":"CDM"},{"code":"300","type":"RC"},{"code":"84704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":199,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Lactate Lactic Acid","code_information":[{"code":"4000280","type":"CDM"},{"code":"300","type":"RC"},{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":198,"gross_charge":248,"discounted_cash":248,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"Inf Agent Antigen Detection Flu A & B","code_information":[{"code":"4000203","type":"CDM"},{"code":"300","type":"RC"},{"code":"87400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":198,"gross_charge":248,"discounted_cash":248,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"Antibody Rubella","code_information":[{"code":"4000046","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":198,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"Antibody Toxoplasma","code_information":[{"code":"4000048","type":"CDM"},{"code":"300","type":"RC"},{"code":"86777","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":198,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"Flagyl 500mg Injection","code_information":[{"code":"8401118","type":"CDM"},{"code":"450","type":"RC"},{"code":"S0030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":198,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"Metronidazole, 10mg Injection","code_information":[{"code":"8409101","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":198,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"N.gonorrhoeae Dna Dir Prob","code_information":[{"code":"8400765","type":"CDM"},{"code":"300","type":"RC"},{"code":"87590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":198,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"Drug Screen Qualitative Sngl Drug Class","code_information":[{"code":"4000131","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":197,"gross_charge":246,"discounted_cash":246,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":197}]}]},{"description":"Hepatitis C Antibody","code_information":[{"code":"4000181","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":196,"gross_charge":245,"discounted_cash":245,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"I And D Hematoma Seroma Fluid Collection","code_information":[{"code":"8500074","type":"CDM"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":924,"gross_charge":245,"discounted_cash":245,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"Immunoelectrophoresis Other Fluids","code_information":[{"code":"4000192","type":"CDM"},{"code":"300","type":"RC"},{"code":"86325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":196,"gross_charge":245,"discounted_cash":245,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"Immunoelectrophoresis Oth Flus Concentra","code_information":[{"code":"8400640","type":"CDM"},{"code":"300","type":"RC"},{"code":"86325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":196,"gross_charge":245,"discounted_cash":245,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"Triiodothyronine T3 Total Tt4","code_information":[{"code":"4000375","type":"CDM"},{"code":"300","type":"RC"},{"code":"84480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":195,"gross_charge":244,"discounted_cash":244,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":195}]}]},{"description":"Phenytoin Total","code_information":[{"code":"4000316","type":"CDM"},{"code":"300","type":"RC"},{"code":"80185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":194,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":194}]}]},{"description":"Injection Of Sinus Tract Diagnostic","code_information":[{"code":"8500140","type":"CDM"},{"code":"20501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":924,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":194}]}]},{"description":"Dihydroxyvitamin D 126","code_information":[{"code":"4000129","type":"CDM"},{"code":"300","type":"RC"},{"code":"82652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":194,"gross_charge":242,"discounted_cash":242,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":194}]}]},{"description":"Subcutaneous Inf For Therapy/prophylaxis","code_information":[{"code":"8400388","type":"CDM"},{"code":"96371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":194,"gross_charge":242,"discounted_cash":242,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":194}]}]},{"description":"Wound(s) Care Non-selective","code_information":[{"code":"6100021","type":"CDM"},{"code":"420","type":"RC"},{"code":"97602","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":192,"maximum":225,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Pro Svc Prv Btw 10 Pm&8 Am At 24-hr Fac","code_information":[{"code":"8500401","type":"CDM"},{"code":"99053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":192,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"Culture Immunofluorscnt Mthd Ea Antiserm","code_information":[{"code":"4000120","type":"CDM"},{"code":"300","type":"RC"},{"code":"87140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":192,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"Culture Type Immunofluoresc","code_information":[{"code":"8400720","type":"CDM"},{"code":"300","type":"RC"},{"code":"87140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":192,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"Control Nasal Hemorrhage Anterior Complx","code_information":[{"code":"8400259","type":"CDM"},{"code":"450","type":"RC"},{"code":"30903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":924,"gross_charge":239,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"Drug Test Presumptive","code_information":[{"code":"4000133","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":191,"gross_charge":239,"discounted_cash":239,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"Quantitation Drug Not Elsewhere Specifie","code_information":[{"code":"4000332","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":191,"gross_charge":239,"discounted_cash":239,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"Culture Fungi Mold Yeast Skin Hair Nail","code_information":[{"code":"4000117","type":"CDM"},{"code":"300","type":"RC"},{"code":"87101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":190,"maximum":190,"gross_charge":238,"discounted_cash":238,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"App Mod To 1 Or More Areas Us Ea 15 Min","code_information":[{"code":"5100001","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":190,"maximum":225,"gross_charge":237,"discounted_cash":237,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Phonophoresis","code_information":[{"code":"6100043","type":"CDM"},{"code":"424","type":"RC"},{"code":"97035","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":190,"maximum":225,"gross_charge":237,"discounted_cash":237,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Phonophoresis","code_information":[{"code":"6100044","type":"CDM"},{"code":"424","type":"RC"},{"code":"97035","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":190,"maximum":225,"gross_charge":237,"discounted_cash":237,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Arthrocentesis Aspir&/inj Mjr Jt/ Bursa","code_information":[{"code":"8500149","type":"CDM"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":924,"gross_charge":236,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Insj Temp Ndwellg Bldr Cath Smpl","code_information":[{"code":"8500304","type":"CDM"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":924,"gross_charge":236,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Calcium Ionized","code_information":[{"code":"4000081","type":"CDM"},{"code":"300","type":"RC"},{"code":"82330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":188,"maximum":188,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Blood Typing Rbc Antigen Not Abo/rh Ea","code_information":[{"code":"4000075","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":187,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"Synthes Locking Screws 12mm","code_information":[{"code":"2800741","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":187,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"Antibody Influenza Virus","code_information":[{"code":"4000037","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":186,"gross_charge":233,"discounted_cash":233,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Tsh Antibody","code_information":[{"code":"4000189","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":186,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq Md","code_information":[{"code":"8500134","type":"CDM"},{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":1058,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Strapping Knee","code_information":[{"code":"8400250","type":"CDM"},{"code":"450","type":"RC"},{"code":"29530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":186,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Ear Speculum 4.25 Mm","code_information":[{"code":"8401246","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SPEC3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SPEC3"],"minimum":186,"maximum":186,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Ear Speculum 2.75 Mm","code_information":[{"code":"8401247","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SPEC4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SPEC4"],"minimum":186,"maximum":186,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Disposable Pack W/bowel Syst Vag Spec","code_information":[{"code":"8401324","type":"CDM"},{"code":"450","type":"RC"},{"code":"E0352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":186,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Collagen Cross Links Any Method","code_information":[{"code":"4000094","type":"CDM"},{"code":"300","type":"RC"},{"code":"82497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":185,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"K-wire 1.1mm X102mm","code_information":[{"code":"2800255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":185,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"K-wire 14mm X 102mm","code_information":[{"code":"2800256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":185,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"Whole Blood","code_information":[{"code":"2800753","type":"CDM"},{"code":"382","type":"RC"},{"code":"P9010","type":"HCPCS","modifier":"BL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BL"],"minimum":125,"maximum":184,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":125}]}]},{"description":"Long Arm Splint Shoulder Hand","code_information":[{"code":"8400239","type":"CDM"},{"code":"450","type":"RC"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":184,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Short Arm Splint Forearm-hand Static","code_information":[{"code":"8400240","type":"CDM"},{"code":"450","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":184,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Short Arm Splint Dynamic","code_information":[{"code":"8400241","type":"CDM"},{"code":"450","type":"RC"},{"code":"29126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":184,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Finger Splint Static","code_information":[{"code":"8400242","type":"CDM"},{"code":"940","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":300,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Strapping Toes","code_information":[{"code":"8400252","type":"CDM"},{"code":"450","type":"RC"},{"code":"29550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":184,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Creatine Kinase Tot","code_information":[{"code":"8400517","type":"CDM"},{"code":"300","type":"RC"},{"code":"82550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":184,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Upper Limb Orthosis Nos","code_information":[{"code":"8401343","type":"CDM"},{"code":"450","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":184,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Drug Screen Any Number Drug Classes","code_information":[{"code":"4000132","type":"CDM"},{"code":"310","type":"RC"},{"code":"80300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":183,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Leukocyte Assessment Fecal Qualitative","code_information":[{"code":"4000284","type":"CDM"},{"code":"300","type":"RC"},{"code":"89055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":183,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Creatine Kinase Ck Cpk Isoenzymes","code_information":[{"code":"4000104","type":"CDM"},{"code":"300","type":"RC"},{"code":"82552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":183,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Creatine Kinase Isoenzymes","code_information":[{"code":"8400518","type":"CDM"},{"code":"300","type":"RC"},{"code":"82552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":183,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Synthes 2.7x20mm Cortex Screw","code_information":[{"code":"28007580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":183,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Digoxin","code_information":[{"code":"4000127","type":"CDM"},{"code":"450","type":"RC"},{"code":"80162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Influenza A Or Biaad Eia Inf/b Ea","code_information":[{"code":"8400742","type":"CDM"},{"code":"300","type":"RC"},{"code":"87400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Antibody Hiv1 And Hiv2 Single Assay","code_information":[{"code":"4000034","type":"CDM"},{"code":"300","type":"RC"},{"code":"86703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Hiv 1 And Hiv 2 Antibody Single Assay","code_information":[{"code":"8400671","type":"CDM"},{"code":"300","type":"RC"},{"code":"86703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Hep B Surface Antibody","code_information":[{"code":"8400674","type":"CDM"},{"code":"300","type":"RC"},{"code":"86706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Physostigmine 1mg/ml 2ml","code_information":[{"code":"3000238","type":"CDM"},{"code":"636","type":"RC"},{"code":"17478051002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":182,"maximum":182,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fibrinogen Activity","code_information":[{"code":"4000145","type":"CDM"},{"code":"300","type":"RC"},{"code":"85384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Fibrinogen Activity","code_information":[{"code":"8400620","type":"CDM"},{"code":"300","type":"RC"},{"code":"85384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Antibody Rotavirus","code_information":[{"code":"4000045","type":"CDM"},{"code":"300","type":"RC"},{"code":"86759","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Hydrazaline Hcl 20 Mg/ml 1ml Vial","code_information":[{"code":"3000118","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323061455","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":182,"maximum":182,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Succinycholine Chloride Inj Up To 20 Mg","code_information":[{"code":"8400863","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Hydralazine Hcl Inj Up To 20mg","code_information":[{"code":"8400864","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Inf Agent Detect By Dna/rna N Gonorrhoea","code_information":[{"code":"4000237","type":"CDM"},{"code":"300","type":"RC"},{"code":"87591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"N.gonorrhoeae Dna Amp Prob","code_information":[{"code":"8400766","type":"CDM"},{"code":"300","type":"RC"},{"code":"87591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":182,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Inf Agent Detection Dna/rna Mult Organis","code_information":[{"code":"4000217","type":"CDM"},{"code":"300","type":"RC"},{"code":"87801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":181,"gross_charge":226,"discounted_cash":226,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":181}]}]},{"description":"Detect Agnt Mult Dna Ampli","code_information":[{"code":"8400776","type":"CDM"},{"code":"300","type":"RC"},{"code":"87801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":181,"gross_charge":226,"discounted_cash":226,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":181}]}]},{"description":"Injection Lanreotide 1 Mg","code_information":[{"code":"8400916","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Blood test, clotting time","code_information":[{"code":"4000274","type":"CDM"},{"code":"301","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Myoglobin","code_information":[{"code":"4000300","type":"CDM"},{"code":"300","type":"RC"},{"code":"83874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Myoglobin","code_information":[{"code":"8400557","type":"CDM"},{"code":"300","type":"RC"},{"code":"83874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Isolat/extract Highly Purified Nucl Acid","code_information":[{"code":"8400559","type":"CDM"},{"code":"300","type":"RC"},{"code":"83891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"8400624","type":"CDM"},{"code":"301","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Synthes 3.5 Cortex Screw 26mm","code_information":[{"code":"2800593","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Synthes 3.5mm Cortex Screw 34mm","code_information":[{"code":"2800601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Arthrex .062 X12 Guidewire","code_information":[{"code":"2800747","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Antibody Herpes Simplex Type 1","code_information":[{"code":"4000031","type":"CDM"},{"code":"300","type":"RC"},{"code":"86695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Culture Bacterial Quantitative Aerobic","code_information":[{"code":"4000110","type":"CDM"},{"code":"300","type":"RC"},{"code":"87071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":180,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Antibody Mumps","code_information":[{"code":"4000038","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":179,"gross_charge":224,"discounted_cash":224,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Wedge Excision Skin Nail Fold","code_information":[{"code":"8500093","type":"CDM"},{"code":"11765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":924,"gross_charge":223,"discounted_cash":223,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Creactive Protein High Sensitivity Hscrp","code_information":[{"code":"4000102","type":"CDM"},{"code":"300","type":"RC"},{"code":"86141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":223,"discounted_cash":223,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Immunoassay Analyte Quantitative","code_information":[{"code":"4000190","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":223,"discounted_cash":223,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Culture Bacterial Aerobic Isolate","code_information":[{"code":"4000262","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Hiv-1 Quant&revrse Trnscrp","code_information":[{"code":"8400763","type":"CDM"},{"code":"300","type":"RC"},{"code":"87536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Mod Sed Same Phys/qhp Ea","code_information":[{"code":"2600001","type":"CDM"},{"code":"370","type":"RC"},{"code":"99153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Inf Agent Antigen Influenza","code_information":[{"code":"4000210","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Rhythm Ecg One To Three Leads W Interpre","code_information":[{"code":"4200018","type":"CDM"},{"code":"730","type":"RC"},{"code":"93040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Rhythm Ecg 1-3 Lds W/i&r","code_information":[{"code":"8400363","type":"CDM"},{"code":"450","type":"RC"},{"code":"93040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Mod Sed Same Phys/qhp Ea","code_information":[{"code":"8400407","type":"CDM"},{"code":"370","type":"RC"},{"code":"99153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Detect Agnt Mult Dna Direc","code_information":[{"code":"8400775","type":"CDM"},{"code":"300","type":"RC"},{"code":"87800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Inf Agt Antgn Dtct Im W/dir Opt Obsinflu","code_information":[{"code":"8400778","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":178,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Word Bartholin Catheter","code_information":[{"code":"8401165","type":"CDM"},{"code":"270","type":"RC"},{"code":"99070","type":"CPT","modifier":"WOCAT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["WOCAT"],"minimum":178,"maximum":178,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Sputum Obtaining Specimen Aerosol","code_information":[{"code":"4000351","type":"CDM"},{"code":"300","type":"RC"},{"code":"89220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":177,"gross_charge":221,"discounted_cash":221,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Control Of Nosebleed","code_information":[{"code":"8500260","type":"CDM"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":924,"gross_charge":221,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Cocaine Nasal 4%","code_information":[{"code":"3060936","type":"CDM"},{"code":"250","type":"RC"},{"code":"64950036204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":177,"maximum":177,"gross_charge":221,"discounted_cash":221,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acetylcysteine 10% 30 Ml","code_information":[{"code":"3060810","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Acromioplasty/acromionectomy Prtl Add 1","code_information":[{"code":"2200003","type":"CDM"},{"code":"360","type":"RC"},{"code":"23130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Adenoidectomy Primary =>Age 12 Add 1 M","code_information":[{"code":"2200005","type":"CDM"},{"code":"360","type":"RC"},{"code":"42831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Adenoidectomy Primary <Age 12 Add 1 Min","code_information":[{"code":"2200007","type":"CDM"},{"code":"360","type":"RC"},{"code":"42830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Adenoidectomy Secondary =>Age 12 Add 1","code_information":[{"code":"2200009","type":"CDM"},{"code":"360","type":"RC"},{"code":"42836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Amputation Penis Partial Add 1 Min","code_information":[{"code":"2200035","type":"CDM"},{"code":"360","type":"RC"},{"code":"54120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Amputation Of Finger/thumb Add","code_information":[{"code":"2200037","type":"CDM"},{"code":"360","type":"RC"},{"code":"26951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Amputation Foot Midtarsal Add 1 Min","code_information":[{"code":"2200041","type":"CDM"},{"code":"360","type":"RC"},{"code":"28800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Amputation Leg Through Tibia & Fibula A","code_information":[{"code":"2200045","type":"CDM"},{"code":"360","type":"RC"},{"code":"27880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Amp Leg Through Tibia&fibula Re-amp Add","code_information":[{"code":"2200047","type":"CDM"},{"code":"360","type":"RC"},{"code":"27886","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Amputation Metatarsal W/ Toe Single Add","code_information":[{"code":"2200049","type":"CDM"},{"code":"360","type":"RC"},{"code":"28810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Amputation Toe Interphalangeal Joint Add","code_information":[{"code":"2200051","type":"CDM"},{"code":"360","type":"RC"},{"code":"28825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Amputation Toe Mtp Joint Add 1 Min","code_information":[{"code":"2200053","type":"CDM"},{"code":"360","type":"RC"},{"code":"28820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Anterior Colporrhaphy","code_information":[{"code":"2200059","type":"CDM"},{"code":"360","type":"RC"},{"code":"57240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ant Vesicoure/urethropexy Cmp Add 1 Min","code_information":[{"code":"2200067","type":"CDM"},{"code":"360","type":"RC"},{"code":"51841","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Appendectomy Add 1 Min","code_information":[{"code":"2200071","type":"CDM"},{"code":"360","type":"RC"},{"code":"44950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Appendectomy","code_information":[{"code":"2200075","type":"CDM"},{"code":"360","type":"RC"},{"code":"44955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthrodesis Great Toe Ipj Add 1 Min","code_information":[{"code":"2200135","type":"CDM"},{"code":"360","type":"RC"},{"code":"28755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthrodesis Great Toe Mtp Joint Add 15 M","code_information":[{"code":"2200137","type":"CDM"},{"code":"360","type":"RC"},{"code":"28750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthrodesis Ipj W/wo Int Fixation Add 15","code_information":[{"code":"2200139","type":"CDM"},{"code":"360","type":"RC"},{"code":"26860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthrodesis Interphal Joint W/wo Int Fix","code_information":[{"code":"2200141","type":"CDM"},{"code":"360","type":"RC"},{"code":"26861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Fusion Of Foot Bones","code_information":[{"code":"2200149","type":"CDM"},{"code":"360","type":"RC"},{"code":"28735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Fusion Of Foot Bones","code_information":[{"code":"2200151","type":"CDM"},{"code":"360","type":"RC"},{"code":"28740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Fusion Of Big Toe Joint","code_information":[{"code":"2200170","type":"CDM"},{"code":"360","type":"RC"},{"code":"28760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Foot Bones","code_information":[{"code":"2200172","type":"CDM"},{"code":"360","type":"RC"},{"code":"28737","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthrodesis Subtalar","code_information":[{"code":"2200174","type":"CDM"},{"code":"360","type":"RC"},{"code":"28725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthro W/prosth Replace Trapezium Add","code_information":[{"code":"2200178","type":"CDM"},{"code":"360","type":"RC"},{"code":"25445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ankle Arthroscopy/surgery","code_information":[{"code":"2200205","type":"CDM"},{"code":"360","type":"RC"},{"code":"29892","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200209","type":"CDM"},{"code":"360","type":"RC"},{"code":"29850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Tibial Arthroscopy/surgery","code_information":[{"code":"2200211","type":"CDM"},{"code":"360","type":"RC"},{"code":"29855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ankle Arthroscopy/surgery","code_information":[{"code":"2200213","type":"CDM"},{"code":"360","type":"RC"},{"code":"29898","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ankle Arthroscopy/surgery","code_information":[{"code":"2200217","type":"CDM"},{"code":"360","type":"RC"},{"code":"29895","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Elbow Arthroscopy","code_information":[{"code":"2200223","type":"CDM"},{"code":"360","type":"RC"},{"code":"29830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthroscopy Elbow Debride Extens Add 15","code_information":[{"code":"2200225","type":"CDM"},{"code":"360","type":"RC"},{"code":"29838","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy Dx","code_information":[{"code":"2200229","type":"CDM"},{"code":"360","type":"RC"},{"code":"29870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200231","type":"CDM"},{"code":"360","type":"RC"},{"code":"29879","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200233","type":"CDM"},{"code":"360","type":"RC"},{"code":"29877","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200235","type":"CDM"},{"code":"360","type":"RC"},{"code":"29885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthroscopy Knee Infect/lav/drain Add 15","code_information":[{"code":"2200237","type":"CDM"},{"code":"360","type":"RC"},{"code":"29871","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200239","type":"CDM"},{"code":"360","type":"RC"},{"code":"29874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200241","type":"CDM"},{"code":"360","type":"RC"},{"code":"29875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthro Knee Surg W/lat Release","code_information":[{"code":"2200245","type":"CDM"},{"code":"360","type":"RC"},{"code":"29873","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200247","type":"CDM"},{"code":"360","type":"RC"},{"code":"29884","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200249","type":"CDM"},{"code":"360","type":"RC"},{"code":"29880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal of one knee cartilage using an endoscope","code_information":[{"code":"2200251","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthroscopy Knee W/meniscs Rep Med/lat A","code_information":[{"code":"2200253","type":"CDM"},{"code":"360","type":"RC"},{"code":"29882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthroscopy Shoulder Debrid Exten","code_information":[{"code":"2200261","type":"CDM"},{"code":"360","type":"RC"},{"code":"29823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthroscopy Shoulder Debride Lmtd","code_information":[{"code":"2200263","type":"CDM"},{"code":"360","type":"RC"},{"code":"29822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthroscopy Shoulder Synovectomy Cmp","code_information":[{"code":"2200271","type":"CDM"},{"code":"360","type":"RC"},{"code":"29821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Shoulder Arthroscopy/surgery","code_information":[{"code":"2200273","type":"CDM"},{"code":"360","type":"RC"},{"code":"29825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthroscopy Shoulder W/removal Lb/fb","code_information":[{"code":"2200275","type":"CDM"},{"code":"360","type":"RC"},{"code":"29819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthroscopy Subtalar Joint W/debride","code_information":[{"code":"2200279","type":"CDM"},{"code":"360","type":"RC"},{"code":"29906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Wrist Arthroscopy","code_information":[{"code":"2200281","type":"CDM"},{"code":"360","type":"RC"},{"code":"29840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Wrist Arthroscopy/surgery","code_information":[{"code":"2200283","type":"CDM"},{"code":"360","type":"RC"},{"code":"29846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Explore/treat Ankle Joint","code_information":[{"code":"2200293","type":"CDM"},{"code":"360","type":"RC"},{"code":"27620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exploration Of Knee Joint","code_information":[{"code":"2200303","type":"CDM"},{"code":"360","type":"RC"},{"code":"27310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Explore/treat Knee Joint","code_information":[{"code":"2200305","type":"CDM"},{"code":"360","type":"RC"},{"code":"27331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Arthrotomy With Synovectomy Ankle","code_information":[{"code":"2200313","type":"CDM"},{"code":"360","type":"RC"},{"code":"27625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Augmentation Lower Jaw Bone","code_information":[{"code":"2200325","type":"CDM"},{"code":"360","type":"RC"},{"code":"21125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Balloon Dilation Biliary Ducts","code_information":[{"code":"2200337","type":"CDM"},{"code":"360","type":"RC"},{"code":"47542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Needle Biopsy Lymph Nodes By Needle","code_information":[{"code":"2200364","type":"CDM"},{"code":"360","type":"RC"},{"code":"38505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Shoulder Capsule","code_information":[{"code":"2200435","type":"CDM"},{"code":"360","type":"RC"},{"code":"23462","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Shoulder Capsule","code_information":[{"code":"2200437","type":"CDM"},{"code":"360","type":"RC"},{"code":"23450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Capsulorrhaphy Anterior W/labral Rep Add","code_information":[{"code":"2200439","type":"CDM"},{"code":"360","type":"RC"},{"code":"23455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Capsulotomy Ipj Ea Joint Sep Proc Add 15","code_information":[{"code":"2200441","type":"CDM"},{"code":"360","type":"RC"},{"code":"28272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Release Of Foot Contracture","code_information":[{"code":"2200443","type":"CDM"},{"code":"360","type":"RC"},{"code":"28270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Carpectomy All Bones Proximal Row","code_information":[{"code":"2200445","type":"CDM"},{"code":"360","type":"RC"},{"code":"25215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cartilage Graft Nasal Septum","code_information":[{"code":"2200449","type":"CDM"},{"code":"360","type":"RC"},{"code":"20912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Debridement Bone Incl Epidermis Dermis","code_information":[{"code":"2200451","type":"CDM"},{"code":"360","type":"RC"},{"code":"58340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ablate Inf Turbinate Superf","code_information":[{"code":"2200453","type":"CDM"},{"code":"360","type":"RC"},{"code":"30801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cervical Lymphadenectomy Complete","code_information":[{"code":"2200463","type":"CDM"},{"code":"360","type":"RC"},{"code":"38720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cholecystectomy With Cholangiography","code_information":[{"code":"2200473","type":"CDM"},{"code":"360","type":"RC"},{"code":"47605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Chromotubation Oviduct Inc Mat Add","code_information":[{"code":"2200475","type":"CDM"},{"code":"360","type":"RC"},{"code":"58350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Claviculectomy Partial","code_information":[{"code":"2200482","type":"CDM"},{"code":"360","type":"RC"},{"code":"23120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Hip Socket Fracture","code_information":[{"code":"2200484","type":"CDM"},{"code":"360","type":"RC"},{"code":"27222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"2200495","type":"CDM"},{"code":"360","type":"RC"},{"code":"26755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Fracture Radius/ulna","code_information":[{"code":"2200500","type":"CDM"},{"code":"360","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Closed Tx Nasal Bone Fract W/stabil","code_information":[{"code":"2200512","type":"CDM"},{"code":"360","type":"RC"},{"code":"21320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Closed Tx Septal&nose Fx","code_information":[{"code":"2200516","type":"CDM"},{"code":"360","type":"RC"},{"code":"21337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Fracture Of Radius","code_information":[{"code":"2200524","type":"CDM"},{"code":"360","type":"RC"},{"code":"25520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Closure Enterostomy Lg/sm Intest","code_information":[{"code":"2200538","type":"CDM"},{"code":"360","type":"RC"},{"code":"44620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Closure Esophag/fistula Cervicl Appr","code_information":[{"code":"2200540","type":"CDM"},{"code":"360","type":"RC"},{"code":"43420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Colon","code_information":[{"code":"2200542","type":"CDM"},{"code":"360","type":"RC"},{"code":"44160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Colectomy Partial With Anastomosis","code_information":[{"code":"2200544","type":"CDM"},{"code":"360","type":"RC"},{"code":"44140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Colon","code_information":[{"code":"2200546","type":"CDM"},{"code":"360","type":"RC"},{"code":"44146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Colon","code_information":[{"code":"2200548","type":"CDM"},{"code":"360","type":"RC"},{"code":"44143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Colpopexy Extraperitoneal","code_information":[{"code":"2200568","type":"CDM"},{"code":"360","type":"RC"},{"code":"57282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Conz Of Cervix W/scope Leep","code_information":[{"code":"2200572","type":"CDM"},{"code":"360","type":"RC"},{"code":"57461","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Colposcopy Vagina W/cervix","code_information":[{"code":"2200574","type":"CDM"},{"code":"360","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Combined Anteroposterior Colporrhaphy","code_information":[{"code":"2200578","type":"CDM"},{"code":"360","type":"RC"},{"code":"57260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cmbn Ap Colprhy W/ntrcl Rpr","code_information":[{"code":"2200580","type":"CDM"},{"code":"360","type":"RC"},{"code":"57265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Conization Of Cervix","code_information":[{"code":"2200584","type":"CDM"},{"code":"360","type":"RC"},{"code":"57520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Conization Of Cervix","code_information":[{"code":"2200586","type":"CDM"},{"code":"360","type":"RC"},{"code":"57522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Control Throat Bleeding","code_information":[{"code":"2200599","type":"CDM"},{"code":"360","type":"RC"},{"code":"42962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Coracoacromial Lgmnt Rel W/wo Acromio","code_information":[{"code":"2200603","type":"CDM"},{"code":"360","type":"RC"},{"code":"23415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Penis","code_information":[{"code":"2200605","type":"CDM"},{"code":"360","type":"RC"},{"code":"54430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Correction Hallux Valgus","code_information":[{"code":"2200612","type":"CDM"},{"code":"360","type":"RC"},{"code":"28298","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystotomy For Excision Bladder Tumor","code_information":[{"code":"2200624","type":"CDM"},{"code":"360","type":"RC"},{"code":"51530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy Stone Removal","code_information":[{"code":"2200626","type":"CDM"},{"code":"360","type":"RC"},{"code":"52325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200628","type":"CDM"},{"code":"360","type":"RC"},{"code":"52330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy Inject Material","code_information":[{"code":"2200632","type":"CDM"},{"code":"360","type":"RC"},{"code":"52327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystourethroscopy Separate Procedure","code_information":[{"code":"2200634","type":"CDM"},{"code":"360","type":"RC"},{"code":"52000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200636","type":"CDM"},{"code":"360","type":"RC"},{"code":"52285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystourethro W/drct Vision Int Urethro","code_information":[{"code":"2200638","type":"CDM"},{"code":"360","type":"RC"},{"code":"52276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystouretero W/congen Repr","code_information":[{"code":"2200640","type":"CDM"},{"code":"360","type":"RC"},{"code":"52400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy Chemodenervation","code_information":[{"code":"2200642","type":"CDM"},{"code":"360","type":"RC"},{"code":"52287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Radiotracer","code_information":[{"code":"2200644","type":"CDM"},{"code":"360","type":"RC"},{"code":"52250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Create Passage To Kidney","code_information":[{"code":"2200646","type":"CDM"},{"code":"360","type":"RC"},{"code":"52334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy Removal Of Clots","code_information":[{"code":"2200648","type":"CDM"},{"code":"360","type":"RC"},{"code":"52001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystourethro Cut Ejacul Duct","code_information":[{"code":"2200650","type":"CDM"},{"code":"360","type":"RC"},{"code":"52402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystouretero W/renal Strict","code_information":[{"code":"2200652","type":"CDM"},{"code":"360","type":"RC"},{"code":"52346","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cysto/uretero Stricture Tx","code_information":[{"code":"2200654","type":"CDM"},{"code":"360","type":"RC"},{"code":"52344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cysto/uretero W/up Stricture","code_information":[{"code":"2200656","type":"CDM"},{"code":"360","type":"RC"},{"code":"52345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystourethroscopy With Biopsys","code_information":[{"code":"2200658","type":"CDM"},{"code":"360","type":"RC"},{"code":"52204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200660","type":"CDM"},{"code":"360","type":"RC"},{"code":"52281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200662","type":"CDM"},{"code":"360","type":"RC"},{"code":"52260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200664","type":"CDM"},{"code":"360","type":"RC"},{"code":"52265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy & Duct Catheter","code_information":[{"code":"2200666","type":"CDM"},{"code":"360","type":"RC"},{"code":"52010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200668","type":"CDM"},{"code":"360","type":"RC"},{"code":"52240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200670","type":"CDM"},{"code":"360","type":"RC"},{"code":"52235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200672","type":"CDM"},{"code":"360","type":"RC"},{"code":"52234","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200674","type":"CDM"},{"code":"360","type":"RC"},{"code":"52214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200676","type":"CDM"},{"code":"360","type":"RC"},{"code":"52224","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystourethro W/int Urethro Male","code_information":[{"code":"2200682","type":"CDM"},{"code":"360","type":"RC"},{"code":"52275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200684","type":"CDM"},{"code":"360","type":"RC"},{"code":"52315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200686","type":"CDM"},{"code":"360","type":"RC"},{"code":"52310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200688","type":"CDM"},{"code":"360","type":"RC"},{"code":"52277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cysto W/steroid Inj Into Strict","code_information":[{"code":"2200690","type":"CDM"},{"code":"360","type":"RC"},{"code":"52283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy & Ureter Catheter","code_information":[{"code":"2200692","type":"CDM"},{"code":"360","type":"RC"},{"code":"52005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Biopsy","code_information":[{"code":"2200694","type":"CDM"},{"code":"360","type":"RC"},{"code":"52007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystouretero & Or Pyeloscope","code_information":[{"code":"2200696","type":"CDM"},{"code":"360","type":"RC"},{"code":"52351","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystouretero W/biopsy","code_information":[{"code":"2200698","type":"CDM"},{"code":"360","type":"RC"},{"code":"52354","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystouretero W/stone Remove","code_information":[{"code":"2200701","type":"CDM"},{"code":"360","type":"RC"},{"code":"52352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystouretero W/excise Tumor","code_information":[{"code":"2200703","type":"CDM"},{"code":"360","type":"RC"},{"code":"52355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200705","type":"CDM"},{"code":"360","type":"RC"},{"code":"52305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200707","type":"CDM"},{"code":"360","type":"RC"},{"code":"52301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200709","type":"CDM"},{"code":"360","type":"RC"},{"code":"52300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cysto W/renal Stricture Tx","code_information":[{"code":"2200711","type":"CDM"},{"code":"360","type":"RC"},{"code":"52343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cysto W/ureter Stricture Tx","code_information":[{"code":"2200713","type":"CDM"},{"code":"360","type":"RC"},{"code":"52341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cysto W/up Stricture Tx","code_information":[{"code":"2200715","type":"CDM"},{"code":"360","type":"RC"},{"code":"52342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cystoscopy And Treatment","code_information":[{"code":"2200717","type":"CDM"},{"code":"278","type":"RC"},{"code":"52290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Debridement Muscle &/Or Fascia","code_information":[{"code":"2200726","type":"CDM"},{"code":"360","type":"RC"},{"code":"11046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Debride Abdom Wall","code_information":[{"code":"2200732","type":"CDM"},{"code":"360","type":"RC"},{"code":"11005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Clean Out Mastoid Cavity","code_information":[{"code":"2200740","type":"CDM"},{"code":"360","type":"RC"},{"code":"69222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Clean Out Mastoid Cavity","code_information":[{"code":"2200742","type":"CDM"},{"code":"360","type":"RC"},{"code":"69220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Debride Skin Subq Tissue & Muscle","code_information":[{"code":"2200748","type":"CDM"},{"code":"360","type":"RC"},{"code":"11043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Decompression Of Forearm","code_information":[{"code":"2200756","type":"CDM"},{"code":"360","type":"RC"},{"code":"24495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Decompression Of Lower Leg","code_information":[{"code":"2200758","type":"CDM"},{"code":"360","type":"RC"},{"code":"27600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Decompression Of Leg","code_information":[{"code":"2200760","type":"CDM"},{"code":"360","type":"RC"},{"code":"27894","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Decompression Fasciotomy W/debridement","code_information":[{"code":"2200762","type":"CDM"},{"code":"360","type":"RC"},{"code":"27694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Decompression Plantar Digital Nerve","code_information":[{"code":"2200764","type":"CDM"},{"code":"360","type":"RC"},{"code":"64726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Delayed Breast Prosthesis","code_information":[{"code":"2200770","type":"CDM"},{"code":"360","type":"RC"},{"code":"19342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Dilate Esophagus 1/mult Pass","code_information":[{"code":"2200811","type":"CDM"},{"code":"360","type":"RC"},{"code":"43450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Dilate Urethra Stricture","code_information":[{"code":"2200813","type":"CDM"},{"code":"360","type":"RC"},{"code":"53620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Dilate Urethra Stricture","code_information":[{"code":"2200815","type":"CDM"},{"code":"360","type":"RC"},{"code":"53600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Dilate Urethra Stricture","code_information":[{"code":"2200817","type":"CDM"},{"code":"360","type":"RC"},{"code":"53605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Disarticulation At Knee","code_information":[{"code":"2200819","type":"CDM"},{"code":"360","type":"RC"},{"code":"27598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Dissection Deep Jugular Nodes","code_information":[{"code":"2200821","type":"CDM"},{"code":"360","type":"RC"},{"code":"38542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Esophagus Pouch","code_information":[{"code":"2200823","type":"CDM"},{"code":"360","type":"RC"},{"code":"43130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Foot Fascia","code_information":[{"code":"2200825","type":"CDM"},{"code":"360","type":"RC"},{"code":"28250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Drain Ext Ear Abscess/hematoma Smpl","code_information":[{"code":"2200833","type":"CDM"},{"code":"360","type":"RC"},{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Drainage Retroperitoneal Abscess Open","code_information":[{"code":"2200843","type":"CDM"},{"code":"360","type":"RC"},{"code":"49060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Dress/debrid P-thick Burn L","code_information":[{"code":"2200849","type":"CDM"},{"code":"360","type":"RC"},{"code":"16030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Dress/debrid P-thick Burn M","code_information":[{"code":"2200851","type":"CDM"},{"code":"360","type":"RC"},{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Endoscopic Injection/implant","code_information":[{"code":"2200869","type":"CDM"},{"code":"360","type":"RC"},{"code":"51715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Endoscopic Plantar Fasciotomy","code_information":[{"code":"2200871","type":"CDM"},{"code":"360","type":"RC"},{"code":"29893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ercp Remove Forgn Body Duct","code_information":[{"code":"2200875","type":"CDM"},{"code":"360","type":"RC"},{"code":"43275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Endo Cholangiopancreatograph","code_information":[{"code":"2200877","type":"CDM"},{"code":"360","type":"RC"},{"code":"43262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ercp Ea Duct/ampulla Dilate","code_information":[{"code":"2200879","type":"CDM"},{"code":"360","type":"RC"},{"code":"43277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Wrist Endoscopy/surgery","code_information":[{"code":"2200883","type":"CDM"},{"code":"360","type":"RC"},{"code":"29848","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Small Intestine","code_information":[{"code":"2200889","type":"CDM"},{"code":"360","type":"RC"},{"code":"44120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Freeing Of Bowel Adhesion","code_information":[{"code":"2200891","type":"CDM"},{"code":"360","type":"RC"},{"code":"44005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Egd Esophagogastrc Fndoplsty","code_information":[{"code":"2200914","type":"CDM"},{"code":"360","type":"RC"},{"code":"43210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exchange Intraocular Lens","code_information":[{"code":"2200927","type":"CDM"},{"code":"360","type":"RC"},{"code":"66986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1868,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Ulna","code_information":[{"code":"2200933","type":"CDM"},{"code":"360","type":"RC"},{"code":"25240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Reremove Wrist Tendon Lesion","code_information":[{"code":"2200953","type":"CDM"},{"code":"360","type":"RC"},{"code":"25112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excise Parotid Gland/lesion","code_information":[{"code":"2200997","type":"CDM"},{"code":"360","type":"RC"},{"code":"42415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excise Parotid Gland/lesion","code_information":[{"code":"2200999","type":"CDM"},{"code":"360","type":"RC"},{"code":"42410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excise Parotid Gland/lesion","code_information":[{"code":"2201001","type":"CDM"},{"code":"360","type":"RC"},{"code":"42420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Femur Lesion","code_information":[{"code":"2201039","type":"CDM"},{"code":"360","type":"RC"},{"code":"27355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Toe Lesions","code_information":[{"code":"2201045","type":"CDM"},{"code":"360","type":"RC"},{"code":"28108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Ankle/heel Lesion","code_information":[{"code":"2201047","type":"CDM"},{"code":"360","type":"RC"},{"code":"28100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Foot Lesion","code_information":[{"code":"2201051","type":"CDM"},{"code":"360","type":"RC"},{"code":"28104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Lower Leg Bone Lesion","code_information":[{"code":"2201055","type":"CDM"},{"code":"360","type":"RC"},{"code":"27635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excision Of Lingual Tonsil","code_information":[{"code":"2201059","type":"CDM"},{"code":"360","type":"RC"},{"code":"42870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treatment Of Urethra Lesion","code_information":[{"code":"2201065","type":"CDM"},{"code":"360","type":"RC"},{"code":"53265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exc Abdl Tum Deep 5 Cm/>","code_information":[{"code":"2201077","type":"CDM"},{"code":"360","type":"RC"},{"code":"22901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exc Neck Tum Deep 5 Cm/>","code_information":[{"code":"2201087","type":"CDM"},{"code":"360","type":"RC"},{"code":"21554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exc Neck Tum Deep < 5 Cm","code_information":[{"code":"2201099","type":"CDM"},{"code":"360","type":"RC"},{"code":"21556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exc Abdl Tum Deep < 5 Cm","code_information":[{"code":"2201103","type":"CDM"},{"code":"360","type":"RC"},{"code":"22900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exc Skin Abd","code_information":[{"code":"2201131","type":"CDM"},{"code":"360","type":"RC"},{"code":"15830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excise Excess Skin & Tissue","code_information":[{"code":"2201137","type":"CDM"},{"code":"360","type":"RC"},{"code":"15839","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excise Excess Skin Fat Pad","code_information":[{"code":"2201139","type":"CDM"},{"code":"360","type":"RC"},{"code":"15838","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excision Nasal Polyps Extensive","code_information":[{"code":"2201170","type":"CDM"},{"code":"360","type":"RC"},{"code":"30115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excision Olecranon Bursa","code_information":[{"code":"2201174","type":"CDM"},{"code":"360","type":"RC"},{"code":"24105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Sacrum Pressure Sore","code_information":[{"code":"2201188","type":"CDM"},{"code":"360","type":"RC"},{"code":"15934","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exc Shoulder Les Sc 3 Cm/>","code_information":[{"code":"2201223","type":"CDM"},{"code":"360","type":"RC"},{"code":"23071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Explore Wound Abdomen","code_information":[{"code":"2201241","type":"CDM"},{"code":"360","type":"RC"},{"code":"20102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exploration Of Abdomen","code_information":[{"code":"2201253","type":"CDM"},{"code":"360","type":"RC"},{"code":"49000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Release Palm Contracture","code_information":[{"code":"2201259","type":"CDM"},{"code":"360","type":"RC"},{"code":"26121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Pedicle E/n/e/l/ntroral","code_information":[{"code":"2201285","type":"CDM"},{"code":"360","type":"RC"},{"code":"15576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Gastroplasty W/o V-band","code_information":[{"code":"2201306","type":"CDM"},{"code":"360","type":"RC"},{"code":"43843","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Calf Tendon","code_information":[{"code":"2201308","type":"CDM"},{"code":"360","type":"RC"},{"code":"27687","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Corrj Halux Rigdus W/implt","code_information":[{"code":"2201322","type":"CDM"},{"code":"360","type":"RC"},{"code":"28291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Corrj Halux Rigdus W/o Implt","code_information":[{"code":"2201324","type":"CDM"},{"code":"360","type":"RC"},{"code":"28289","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Toe","code_information":[{"code":"2201328","type":"CDM"},{"code":"360","type":"RC"},{"code":"28160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Hysteroscopy Sterilization","code_information":[{"code":"2201351","type":"CDM"},{"code":"360","type":"RC"},{"code":"58565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Immediate Breast Prosthesis","code_information":[{"code":"2201365","type":"CDM"},{"code":"360","type":"RC"},{"code":"19340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"I&d Abscess P-spine L/s/ls","code_information":[{"code":"2201413","type":"CDM"},{"code":"360","type":"RC"},{"code":"22015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Induced Abortion By Dilation&curettage","code_information":[{"code":"2201433","type":"CDM"},{"code":"360","type":"RC"},{"code":"59840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Groin Lymph Nodes","code_information":[{"code":"2201437","type":"CDM"},{"code":"360","type":"RC"},{"code":"38760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Inj Platelet Rich Plasma Any Site","code_information":[{"code":"2201477","type":"CDM"},{"code":"360","type":"RC"},{"code":"0232T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Insert Uro/ves Nck Sphincter","code_information":[{"code":"2201543","type":"CDM"},{"code":"360","type":"RC"},{"code":"53445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Insert Multi-comp Penis Pros","code_information":[{"code":"2201553","type":"CDM"},{"code":"360","type":"RC"},{"code":"54405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Insert Temp Bladder Cath","code_information":[{"code":"2201565","type":"CDM"},{"code":"360","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Insert Tunneled Cv Cath","code_information":[{"code":"2201569","type":"CDM"},{"code":"360","type":"RC"},{"code":"36563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Insert Tunneled Cv Cath","code_information":[{"code":"2201571","type":"CDM"},{"code":"360","type":"RC"},{"code":"36561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Intern Neurolysis W Operating Microscop","code_information":[{"code":"2201582","type":"CDM"},{"code":"360","type":"RC"},{"code":"64727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Ectopic Pregnancy","code_information":[{"code":"2201627","type":"CDM"},{"code":"360","type":"RC"},{"code":"59151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Myotomy Heller","code_information":[{"code":"2201629","type":"CDM"},{"code":"360","type":"RC"},{"code":"43279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Paraesoph Her Rpr W/mesh","code_information":[{"code":"2201631","type":"CDM"},{"code":"360","type":"RC"},{"code":"43282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Inc Hern Recur Comp","code_information":[{"code":"2201633","type":"CDM"},{"code":"360","type":"RC"},{"code":"49657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Inc Hernia Repair Recur","code_information":[{"code":"2201635","type":"CDM"},{"code":"360","type":"RC"},{"code":"49656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Enterolysis","code_information":[{"code":"2201643","type":"CDM"},{"code":"360","type":"RC"},{"code":"44180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Fundoplasty","code_information":[{"code":"2201645","type":"CDM"},{"code":"360","type":"RC"},{"code":"43280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Gastric Bypass/roux-en-y","code_information":[{"code":"2201657","type":"CDM"},{"code":"360","type":"RC"},{"code":"43644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Takedown Splenic Flex","code_information":[{"code":"2201659","type":"CDM"},{"code":"360","type":"RC"},{"code":"44213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopic Myomectomy","code_information":[{"code":"2201661","type":"CDM"},{"code":"360","type":"RC"},{"code":"58545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1868,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Paraesophag Hern Repair","code_information":[{"code":"2201663","type":"CDM"},{"code":"360","type":"RC"},{"code":"43281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Inc Hern Repair Comp","code_information":[{"code":"2201665","type":"CDM"},{"code":"360","type":"RC"},{"code":"49655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Vent/abd Hernia Repair","code_information":[{"code":"2201671","type":"CDM"},{"code":"360","type":"RC"},{"code":"49652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Splenectomy","code_information":[{"code":"2201673","type":"CDM"},{"code":"360","type":"RC"},{"code":"38120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lsh Uterus 250 G Or Less","code_information":[{"code":"2201675","type":"CDM"},{"code":"360","type":"RC"},{"code":"58541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lsh W/t/o Ut 250 G Or Less","code_information":[{"code":"2201677","type":"CDM"},{"code":"360","type":"RC"},{"code":"58542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lsh Uterus Above 250 G","code_information":[{"code":"2201679","type":"CDM"},{"code":"360","type":"RC"},{"code":"58543","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lsh W/t/o Uterus Above 250 G","code_information":[{"code":"2201681","type":"CDM"},{"code":"360","type":"RC"},{"code":"58544","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Tlh W/t/o 250 G Or Less","code_information":[{"code":"2201687","type":"CDM"},{"code":"360","type":"RC"},{"code":"58571","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1868,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparo-vag Hyst Incl T/o","code_information":[{"code":"2201689","type":"CDM"},{"code":"360","type":"RC"},{"code":"58552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal of gallbladder using an endoscope","code_information":[{"code":"2201697","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"47562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparo Cholecystectomy/graph","code_information":[{"code":"2201699","type":"CDM"},{"code":"360","type":"RC"},{"code":"47563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparo Cholecystectomy/explr","code_information":[{"code":"2201701","type":"CDM"},{"code":"360","type":"RC"},{"code":"47564","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"L Colectomy/coloproctostomy","code_information":[{"code":"2201705","type":"CDM"},{"code":"360","type":"RC"},{"code":"44207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lap Colectomy Part W/ileum","code_information":[{"code":"2201707","type":"CDM"},{"code":"360","type":"RC"},{"code":"44205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Aspiration","code_information":[{"code":"2201713","type":"CDM"},{"code":"360","type":"RC"},{"code":"49322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Biopsy","code_information":[{"code":"2201715","type":"CDM"},{"code":"360","type":"RC"},{"code":"49321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Tubal Cautery","code_information":[{"code":"2201717","type":"CDM"},{"code":"360","type":"RC"},{"code":"58670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Excise Lesions","code_information":[{"code":"2201719","type":"CDM"},{"code":"360","type":"RC"},{"code":"58662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Lysis","code_information":[{"code":"2201723","type":"CDM"},{"code":"360","type":"RC"},{"code":"58660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Tubal Block","code_information":[{"code":"2201725","type":"CDM"},{"code":"360","type":"RC"},{"code":"58671","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Remove Adnexa","code_information":[{"code":"2201727","type":"CDM"},{"code":"360","type":"RC"},{"code":"58661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laryngoscopy W/biopsy","code_information":[{"code":"2201729","type":"CDM"},{"code":"360","type":"RC"},{"code":"31535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laryngoscopy W/bx & Op Scope","code_information":[{"code":"2201731","type":"CDM"},{"code":"360","type":"RC"},{"code":"31536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laryngoscopy W/exc Of Tumor","code_information":[{"code":"2201733","type":"CDM"},{"code":"360","type":"RC"},{"code":"31540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Larynscop W/tumr Exc + Scope","code_information":[{"code":"2201735","type":"CDM"},{"code":"360","type":"RC"},{"code":"31541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Vc Lesion W/scope","code_information":[{"code":"2201737","type":"CDM"},{"code":"360","type":"RC"},{"code":"31545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laryngoscopy Indirect With Biopsy","code_information":[{"code":"2201745","type":"CDM"},{"code":"360","type":"RC"},{"code":"31510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lateral Retinacular Release Open","code_information":[{"code":"2201752","type":"CDM"},{"code":"360","type":"RC"},{"code":"27425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Lower Leg Tendons","code_information":[{"code":"2201774","type":"CDM"},{"code":"360","type":"RC"},{"code":"27686","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Lower Leg Tendon","code_information":[{"code":"2201776","type":"CDM"},{"code":"360","type":"RC"},{"code":"27685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Liga Hemorrhoid Vas Bund Includ Us Guid","code_information":[{"code":"2201784","type":"CDM"},{"code":"360","type":"RC"},{"code":"0249T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Bladder Stone Comp","code_information":[{"code":"2201788","type":"CDM"},{"code":"360","type":"RC"},{"code":"52318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Lumbar Cervical","code_information":[{"code":"2201793","type":"CDM"},{"code":"360","type":"RC"},{"code":"28715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Adhesiolysis Tube Ovary","code_information":[{"code":"2201797","type":"CDM"},{"code":"360","type":"RC"},{"code":"58740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Enlarge Breast","code_information":[{"code":"2201805","type":"CDM"},{"code":"360","type":"RC"},{"code":"19324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"P-mastectomy W/ln Removal","code_information":[{"code":"2201824","type":"CDM"},{"code":"360","type":"RC"},{"code":"19302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Takedown Splenic Flexure W Colectomy","code_information":[{"code":"2201841","type":"CDM"},{"code":"360","type":"RC"},{"code":"44139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Muscle-skin Graft Leg","code_information":[{"code":"2201843","type":"CDM"},{"code":"360","type":"RC"},{"code":"15738","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Myomectomy Abdom Complex","code_information":[{"code":"2201852","type":"CDM"},{"code":"360","type":"RC"},{"code":"58146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Eardrum","code_information":[{"code":"2201854","type":"CDM"},{"code":"360","type":"RC"},{"code":"69620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nasal Endoscopy Dx","code_information":[{"code":"2201859","type":"CDM"},{"code":"360","type":"RC"},{"code":"31231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc Dx Max Sinusc","code_information":[{"code":"2201869","type":"CDM"},{"code":"360","type":"RC"},{"code":"31233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc Dx Sphn Sinusc","code_information":[{"code":"2201871","type":"CDM"},{"code":"360","type":"RC"},{"code":"31235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc Frnt Tiss Rmvl","code_information":[{"code":"2201873","type":"CDM"},{"code":"360","type":"RC"},{"code":"31276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Exploration Maxillary Sinus","code_information":[{"code":"2201875","type":"CDM"},{"code":"360","type":"RC"},{"code":"31256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Endoscopy Maxillary Sinus","code_information":[{"code":"2201877","type":"CDM"},{"code":"360","type":"RC"},{"code":"31267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nasal/sinus Endoscopy Surg","code_information":[{"code":"2201879","type":"CDM"},{"code":"360","type":"RC"},{"code":"31290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nasal/sinus Endoscopy Surg","code_information":[{"code":"2201881","type":"CDM"},{"code":"360","type":"RC"},{"code":"31291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nasal/sinus Endoscopy Surg","code_information":[{"code":"2201883","type":"CDM"},{"code":"360","type":"RC"},{"code":"31287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nasal/sinus Endoscopy Surg","code_information":[{"code":"2201885","type":"CDM"},{"code":"360","type":"RC"},{"code":"31288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nasal/sinus Endoscopy Surg","code_information":[{"code":"2201887","type":"CDM"},{"code":"360","type":"RC"},{"code":"31237","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc Surg Max Sins","code_information":[{"code":"2201894","type":"CDM"},{"code":"360","type":"RC"},{"code":"31295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc W/prtl Ethmdct","code_information":[{"code":"2201898","type":"CDM"},{"code":"360","type":"RC"},{"code":"31254","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc W/tot Ethmdct","code_information":[{"code":"2201900","type":"CDM"},{"code":"360","type":"RC"},{"code":"31255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc Med/inf Dcmprn","code_information":[{"code":"2201902","type":"CDM"},{"code":"360","type":"RC"},{"code":"31292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc Med&inf Dcmprn","code_information":[{"code":"2201904","type":"CDM"},{"code":"360","type":"RC"},{"code":"31293","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nsl/sins Ndsc Surg On Dcmprn","code_information":[{"code":"2201906","type":"CDM"},{"code":"360","type":"RC"},{"code":"31294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Nerve Repair W/allograft","code_information":[{"code":"2201912","type":"CDM"},{"code":"360","type":"RC"},{"code":"64910","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Cranial Nerve","code_information":[{"code":"2201916","type":"CDM"},{"code":"360","type":"RC"},{"code":"64716","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Carpal Tunnel Surgery","code_information":[{"code":"2201918","type":"CDM"},{"code":"360","type":"RC"},{"code":"64721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Ulnar Nerve At Elbow","code_information":[{"code":"2201920","type":"CDM"},{"code":"360","type":"RC"},{"code":"64718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Ulnar Nerve At Wrist","code_information":[{"code":"2201922","type":"CDM"},{"code":"360","type":"RC"},{"code":"64719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Arm Nerve(s)","code_information":[{"code":"2201924","type":"CDM"},{"code":"360","type":"RC"},{"code":"64713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Low Back Nerve(s)","code_information":[{"code":"2201926","type":"CDM"},{"code":"360","type":"RC"},{"code":"64714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Arm/leg Nerve","code_information":[{"code":"2201928","type":"CDM"},{"code":"360","type":"RC"},{"code":"64708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Sciatic Nerve","code_information":[{"code":"2201930","type":"CDM"},{"code":"360","type":"RC"},{"code":"64712","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Finger/toe Nerve","code_information":[{"code":"2201932","type":"CDM"},{"code":"360","type":"RC"},{"code":"64702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Neuroplasty Nerve Hand Or Foot","code_information":[{"code":"2201934","type":"CDM"},{"code":"360","type":"RC"},{"code":"64704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Omentum","code_information":[{"code":"2201938","type":"CDM"},{"code":"360","type":"RC"},{"code":"49255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Clavicle Dislocation","code_information":[{"code":"2201944","type":"CDM"},{"code":"360","type":"RC"},{"code":"23550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Clavicle Dislocation","code_information":[{"code":"2201946","type":"CDM"},{"code":"360","type":"RC"},{"code":"23552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"2201950","type":"CDM"},{"code":"360","type":"RC"},{"code":"26746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Heel Fracture","code_information":[{"code":"2201954","type":"CDM"},{"code":"360","type":"RC"},{"code":"28415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Clavicle Fracture","code_information":[{"code":"2201958","type":"CDM"},{"code":"360","type":"RC"},{"code":"23515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Open Treatment Coccygeal Fracture","code_information":[{"code":"2201960","type":"CDM"},{"code":"360","type":"RC"},{"code":"27202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Lower Jaw Fracture","code_information":[{"code":"2201962","type":"CDM"},{"code":"360","type":"RC"},{"code":"21470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"2201966","type":"CDM"},{"code":"360","type":"RC"},{"code":"26765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Fx Rad Extra-articul","code_information":[{"code":"2201968","type":"CDM"},{"code":"360","type":"RC"},{"code":"25607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Fx Rad Intra-articul","code_information":[{"code":"2201970","type":"CDM"},{"code":"360","type":"RC"},{"code":"25608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Fx Radial 3+ Frag","code_information":[{"code":"2201972","type":"CDM"},{"code":"360","type":"RC"},{"code":"25609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Lower Leg Joint","code_information":[{"code":"2201974","type":"CDM"},{"code":"360","type":"RC"},{"code":"27829","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treatment Of Thigh Fracture","code_information":[{"code":"2201976","type":"CDM"},{"code":"360","type":"RC"},{"code":"27514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Thigh Fracture","code_information":[{"code":"2201978","type":"CDM"},{"code":"360","type":"RC"},{"code":"27236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treatment Of Thigh Fracture","code_information":[{"code":"2201982","type":"CDM"},{"code":"360","type":"RC"},{"code":"27511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Lower Leg Fracture","code_information":[{"code":"2201986","type":"CDM"},{"code":"360","type":"RC"},{"code":"27828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Lower Leg Fracture","code_information":[{"code":"2201988","type":"CDM"},{"code":"360","type":"RC"},{"code":"27827","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Thigh Fracture","code_information":[{"code":"2201996","type":"CDM"},{"code":"360","type":"RC"},{"code":"27248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"2202000","type":"CDM"},{"code":"360","type":"RC"},{"code":"24575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"2202004","type":"CDM"},{"code":"360","type":"RC"},{"code":"24546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"2202006","type":"CDM"},{"code":"360","type":"RC"},{"code":"24545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Finger Dislocation","code_information":[{"code":"2202010","type":"CDM"},{"code":"360","type":"RC"},{"code":"26785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Lower Jaw Fracture","code_information":[{"code":"2202012","type":"CDM"},{"code":"360","type":"RC"},{"code":"21465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Opn Tx Orbit Periorbtl Implt","code_information":[{"code":"2202022","type":"CDM"},{"code":"360","type":"RC"},{"code":"21390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Opn Tx Orbit Fx Transantral","code_information":[{"code":"2202024","type":"CDM"},{"code":"360","type":"RC"},{"code":"21385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Kneecap Fracture","code_information":[{"code":"2202026","type":"CDM"},{"code":"360","type":"RC"},{"code":"27524","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Radius Fracture","code_information":[{"code":"2202038","type":"CDM"},{"code":"360","type":"RC"},{"code":"24665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Radius Fracture","code_information":[{"code":"2202040","type":"CDM"},{"code":"360","type":"RC"},{"code":"24666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Fracture Of Radius","code_information":[{"code":"2202044","type":"CDM"},{"code":"360","type":"RC"},{"code":"25525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Foot Dislocation","code_information":[{"code":"2202048","type":"CDM"},{"code":"360","type":"RC"},{"code":"28585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Foot Dislocation","code_information":[{"code":"2202052","type":"CDM"},{"code":"360","type":"RC"},{"code":"28615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Knee Fracture","code_information":[{"code":"2202054","type":"CDM"},{"code":"360","type":"RC"},{"code":"27536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Knee Fracture","code_information":[{"code":"2202056","type":"CDM"},{"code":"360","type":"RC"},{"code":"27535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Ulnar Fracture","code_information":[{"code":"2202064","type":"CDM"},{"code":"360","type":"RC"},{"code":"24685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Fracture Of Ulna","code_information":[{"code":"2202066","type":"CDM"},{"code":"360","type":"RC"},{"code":"25545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Open Treatment Ulnar Styloid Fracture","code_information":[{"code":"2202068","type":"CDM"},{"code":"360","type":"RC"},{"code":"25652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Tendon Transfer With Graft","code_information":[{"code":"2202072","type":"CDM"},{"code":"360","type":"RC"},{"code":"26492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ostectomy Calcaneus","code_information":[{"code":"2202080","type":"CDM"},{"code":"360","type":"RC"},{"code":"28118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Heel Spur","code_information":[{"code":"2202082","type":"CDM"},{"code":"360","type":"RC"},{"code":"28119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Part Removal Of Metatarsal","code_information":[{"code":"2202084","type":"CDM"},{"code":"360","type":"RC"},{"code":"28113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Part Removal Of Metatarsal","code_information":[{"code":"2202086","type":"CDM"},{"code":"360","type":"RC"},{"code":"28111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Part Removal Of Metatarsal","code_information":[{"code":"2202088","type":"CDM"},{"code":"360","type":"RC"},{"code":"28112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Ostectomy Excision Tarsal Coalition","code_information":[{"code":"2202090","type":"CDM"},{"code":"360","type":"RC"},{"code":"28116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Part Removal Of Metatarsal","code_information":[{"code":"2202092","type":"CDM"},{"code":"360","type":"RC"},{"code":"28110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Foot Bone","code_information":[{"code":"2202094","type":"CDM"},{"code":"360","type":"RC"},{"code":"28288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Collar Bone","code_information":[{"code":"2202107","type":"CDM"},{"code":"360","type":"RC"},{"code":"23485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Big Toe","code_information":[{"code":"2202111","type":"CDM"},{"code":"360","type":"RC"},{"code":"28310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Midfoot Bones","code_information":[{"code":"2202113","type":"CDM"},{"code":"360","type":"RC"},{"code":"28304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incise/graft Midfoot Bones","code_information":[{"code":"2202115","type":"CDM"},{"code":"360","type":"RC"},{"code":"28305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Osteotomy Fibula","code_information":[{"code":"2202123","type":"CDM"},{"code":"360","type":"RC"},{"code":"27707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Osteotomy Phalanx Finger Each","code_information":[{"code":"2202125","type":"CDM"},{"code":"360","type":"RC"},{"code":"26567","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Osteotomy Talus","code_information":[{"code":"2202127","type":"CDM"},{"code":"360","type":"RC"},{"code":"28302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Ovarian Cyst(s)","code_information":[{"code":"2202133","type":"CDM"},{"code":"360","type":"RC"},{"code":"58925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Palate Pharynx/uvula","code_information":[{"code":"2202135","type":"CDM"},{"code":"360","type":"RC"},{"code":"42145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Excise Anal Ext Tag/papilla","code_information":[{"code":"2202137","type":"CDM"},{"code":"360","type":"RC"},{"code":"46220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Esophagus","code_information":[{"code":"2202139","type":"CDM"},{"code":"360","type":"RC"},{"code":"43122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Fibula","code_information":[{"code":"2202141","type":"CDM"},{"code":"360","type":"RC"},{"code":"27641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Collar Bone Lesion","code_information":[{"code":"2202145","type":"CDM"},{"code":"360","type":"RC"},{"code":"23180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Humerus Lesion","code_information":[{"code":"2202147","type":"CDM"},{"code":"360","type":"RC"},{"code":"23184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Shoulder Blade Lesion","code_information":[{"code":"2202149","type":"CDM"},{"code":"360","type":"RC"},{"code":"23182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Hand Bone","code_information":[{"code":"2202153","type":"CDM"},{"code":"360","type":"RC"},{"code":"26230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Toe","code_information":[{"code":"2202155","type":"CDM"},{"code":"360","type":"RC"},{"code":"28124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Part Removal Of Ankle/heel","code_information":[{"code":"2202157","type":"CDM"},{"code":"360","type":"RC"},{"code":"28120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Foot Bone","code_information":[{"code":"2202159","type":"CDM"},{"code":"360","type":"RC"},{"code":"28122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Thyroid Excision","code_information":[{"code":"2202161","type":"CDM"},{"code":"360","type":"RC"},{"code":"60212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Thyroid Excision","code_information":[{"code":"2202163","type":"CDM"},{"code":"360","type":"RC"},{"code":"60210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Patellectomy Or Hemipatellectomy","code_information":[{"code":"2202165","type":"CDM"},{"code":"360","type":"RC"},{"code":"27350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Pin Hand Dislocation","code_information":[{"code":"2202177","type":"CDM"},{"code":"360","type":"RC"},{"code":"26676","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Pin Finger Fracture Each","code_information":[{"code":"2202179","type":"CDM"},{"code":"360","type":"RC"},{"code":"26756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Thigh Fracture","code_information":[{"code":"2202185","type":"CDM"},{"code":"360","type":"RC"},{"code":"27235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Big Toe Fracture","code_information":[{"code":"2202187","type":"CDM"},{"code":"360","type":"RC"},{"code":"28496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Metacarpal Fracture","code_information":[{"code":"2202193","type":"CDM"},{"code":"360","type":"RC"},{"code":"26608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Metatarsal Fracture","code_information":[{"code":"2202195","type":"CDM"},{"code":"360","type":"RC"},{"code":"28476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"2202197","type":"CDM"},{"code":"360","type":"RC"},{"code":"24538","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Foot Dislocation","code_information":[{"code":"2202199","type":"CDM"},{"code":"360","type":"RC"},{"code":"28606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Percutaneous Vertebroplasty One Vertebra","code_information":[{"code":"2202217","type":"CDM"},{"code":"360","type":"RC"},{"code":"22522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Perineum","code_information":[{"code":"2202219","type":"CDM"},{"code":"360","type":"RC"},{"code":"56810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Reconstruction Of Throat","code_information":[{"code":"2202225","type":"CDM"},{"code":"360","type":"RC"},{"code":"42950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Pterygomaxillary Fossa Any Approach","code_information":[{"code":"2202256","type":"CDM"},{"code":"360","type":"RC"},{"code":"31040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Wrist/forearm Lesion","code_information":[{"code":"2202269","type":"CDM"},{"code":"360","type":"RC"},{"code":"25115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Foot Tendon","code_information":[{"code":"2202298","type":"CDM"},{"code":"360","type":"RC"},{"code":"28238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Unstable Kneecap","code_information":[{"code":"2202304","type":"CDM"},{"code":"360","type":"RC"},{"code":"27420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Unstable Kneecap","code_information":[{"code":"2202306","type":"CDM"},{"code":"360","type":"RC"},{"code":"27422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Reduce Bowel Obstruction","code_information":[{"code":"2202318","type":"CDM"},{"code":"360","type":"RC"},{"code":"44050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1868,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Stent Via Transureth","code_information":[{"code":"2202328","type":"CDM"},{"code":"360","type":"RC"},{"code":"50386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove/replace Penis Prosth","code_information":[{"code":"2202330","type":"CDM"},{"code":"360","type":"RC"},{"code":"54410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove/replace Ur Sphincter","code_information":[{"code":"2202332","type":"CDM"},{"code":"360","type":"RC"},{"code":"53447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Clear Outer Ear Canal","code_information":[{"code":"2202336","type":"CDM"},{"code":"360","type":"RC"},{"code":"69205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Muti-comp Penis Pros","code_information":[{"code":"2202346","type":"CDM"},{"code":"360","type":"RC"},{"code":"54406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Foreign Body Foot Complicated","code_information":[{"code":"2202357","type":"CDM"},{"code":"360","type":"RC"},{"code":"28193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Foreign Body Foot Deep","code_information":[{"code":"2202359","type":"CDM"},{"code":"360","type":"RC"},{"code":"28192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Hip Prosthesis","code_information":[{"code":"2202365","type":"CDM"},{"code":"360","type":"RC"},{"code":"27090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Support Implant","code_information":[{"code":"2202371","type":"CDM"},{"code":"360","type":"RC"},{"code":"20670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Mammary Implant Material","code_information":[{"code":"2202377","type":"CDM"},{"code":"360","type":"RC"},{"code":"19330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Tunneled Cv Cath","code_information":[{"code":"2202408","type":"CDM"},{"code":"360","type":"RC"},{"code":"36589","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Eye Fluid","code_information":[{"code":"2202410","type":"CDM"},{"code":"360","type":"RC"},{"code":"67005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Bone Fixation Device","code_information":[{"code":"2202416","type":"CDM"},{"code":"360","type":"RC"},{"code":"20694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rpr Epigastric Hern Blocked","code_information":[{"code":"2202422","type":"CDM"},{"code":"360","type":"RC"},{"code":"49572","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rpr Ventral Hern Init Block","code_information":[{"code":"2202426","type":"CDM"},{"code":"360","type":"RC"},{"code":"49561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rpr Ventral Hern Init Reduc","code_information":[{"code":"2202428","type":"CDM"},{"code":"360","type":"RC"},{"code":"49560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Prp I/hern Init Block >5 Yr","code_information":[{"code":"2202430","type":"CDM"},{"code":"360","type":"RC"},{"code":"49507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair of groin hernia patient age 5 years or older","code_information":[{"code":"2202432","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"49505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Lumbar Hernia","code_information":[{"code":"2202438","type":"CDM"},{"code":"360","type":"RC"},{"code":"49540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Nasal Septal Perforations","code_information":[{"code":"2202442","type":"CDM"},{"code":"360","type":"RC"},{"code":"30630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Nasal Stenosis W/ Implant","code_information":[{"code":"2202444","type":"CDM"},{"code":"360","type":"RC"},{"code":"C9749","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Tunneled Cv Cath","code_information":[{"code":"2202452","type":"CDM"},{"code":"360","type":"RC"},{"code":"36576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Hand Joint","code_information":[{"code":"2202454","type":"CDM"},{"code":"360","type":"RC"},{"code":"26540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Eyelid Defect","code_information":[{"code":"2202460","type":"CDM"},{"code":"360","type":"RC"},{"code":"67917","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Finger/hand Tendon","code_information":[{"code":"2202464","type":"CDM"},{"code":"360","type":"RC"},{"code":"26426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair/graft Finger Tendon","code_information":[{"code":"2202466","type":"CDM"},{"code":"360","type":"RC"},{"code":"26428","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Finger Tendon","code_information":[{"code":"2202468","type":"CDM"},{"code":"360","type":"RC"},{"code":"26433","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Spinal Herniation","code_information":[{"code":"2202472","type":"CDM"},{"code":"360","type":"RC"},{"code":"63706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Radius Or Ulna","code_information":[{"code":"2202478","type":"CDM"},{"code":"360","type":"RC"},{"code":"25400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Rotator Cuff Acute","code_information":[{"code":"2202484","type":"CDM"},{"code":"360","type":"RC"},{"code":"23410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Hydrocele","code_information":[{"code":"2202488","type":"CDM"},{"code":"360","type":"RC"},{"code":"55060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rerepair Fem Hernia Blocked","code_information":[{"code":"2202500","type":"CDM"},{"code":"360","type":"RC"},{"code":"49557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rerepair Ventrl Hern Reduce","code_information":[{"code":"2202504","type":"CDM"},{"code":"360","type":"RC"},{"code":"49565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rerepair Ing Hernia Blocked","code_information":[{"code":"2202506","type":"CDM"},{"code":"360","type":"RC"},{"code":"49521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rerepair Ing Hernia Reduce","code_information":[{"code":"2202508","type":"CDM"},{"code":"360","type":"RC"},{"code":"49520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rpr Umbil Hern Block > 5 Yr","code_information":[{"code":"2202510","type":"CDM"},{"code":"360","type":"RC"},{"code":"49587","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Rpr Umbil Hern Reduc > 5 Yr","code_information":[{"code":"2202512","type":"CDM"},{"code":"360","type":"RC"},{"code":"49585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Hand Tendon","code_information":[{"code":"2202538","type":"CDM"},{"code":"360","type":"RC"},{"code":"26410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Leg Tendon Each","code_information":[{"code":"2202540","type":"CDM"},{"code":"360","type":"RC"},{"code":"27658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Leg Tendon Each","code_information":[{"code":"2202542","type":"CDM"},{"code":"360","type":"RC"},{"code":"27659","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Muscles Of Hand","code_information":[{"code":"2202546","type":"CDM"},{"code":"360","type":"RC"},{"code":"26591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Thigh","code_information":[{"code":"2202550","type":"CDM"},{"code":"360","type":"RC"},{"code":"27470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Metatarsals","code_information":[{"code":"2202552","type":"CDM"},{"code":"360","type":"RC"},{"code":"28322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Nonunion Or Malunion Tarsal Bones","code_information":[{"code":"2202554","type":"CDM"},{"code":"360","type":"RC"},{"code":"28320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Ankle Ligaments","code_information":[{"code":"2202556","type":"CDM"},{"code":"360","type":"RC"},{"code":"27696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Knee Ligament","code_information":[{"code":"2202564","type":"CDM"},{"code":"360","type":"RC"},{"code":"27405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Achilles Tendon","code_information":[{"code":"2202567","type":"CDM"},{"code":"360","type":"RC"},{"code":"27654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Ankle Ligament","code_information":[{"code":"2202569","type":"CDM"},{"code":"360","type":"RC"},{"code":"27698","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Forearm Tendon/muscle","code_information":[{"code":"2202571","type":"CDM"},{"code":"360","type":"RC"},{"code":"25270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Forearm Tendon/muscle","code_information":[{"code":"2202573","type":"CDM"},{"code":"360","type":"RC"},{"code":"25260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Arm Tendon/muscle","code_information":[{"code":"2202575","type":"CDM"},{"code":"360","type":"RC"},{"code":"24341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Foot Tendon","code_information":[{"code":"2202577","type":"CDM"},{"code":"360","type":"RC"},{"code":"28208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Foot Tendon","code_information":[{"code":"2202579","type":"CDM"},{"code":"360","type":"RC"},{"code":"28200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Foot Tendon","code_information":[{"code":"2202581","type":"CDM"},{"code":"360","type":"RC"},{"code":"28202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Resect Ovarian Malignancy","code_information":[{"code":"2202587","type":"CDM"},{"code":"360","type":"RC"},{"code":"58950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Resection Scrotum","code_information":[{"code":"2202589","type":"CDM"},{"code":"360","type":"RC"},{"code":"55150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Toe","code_information":[{"code":"2202593","type":"CDM"},{"code":"360","type":"RC"},{"code":"28126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Vag Graft Via Vagina","code_information":[{"code":"2202595","type":"CDM"},{"code":"360","type":"RC"},{"code":"57295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Colostomy","code_information":[{"code":"2202603","type":"CDM"},{"code":"360","type":"RC"},{"code":"44340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Hip Joint Replacement","code_information":[{"code":"2202607","type":"CDM"},{"code":"360","type":"RC"},{"code":"27137","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1868,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Reconstruction Of Nose","code_information":[{"code":"2202627","type":"CDM"},{"code":"360","type":"RC"},{"code":"30410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Reconstruction Of Nose","code_information":[{"code":"2202629","type":"CDM"},{"code":"360","type":"RC"},{"code":"30420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Nose","code_information":[{"code":"2202633","type":"CDM"},{"code":"360","type":"RC"},{"code":"30450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revision Of Nose","code_information":[{"code":"2202635","type":"CDM"},{"code":"360","type":"RC"},{"code":"30430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Late Closure Of Wound","code_information":[{"code":"2202645","type":"CDM"},{"code":"360","type":"RC"},{"code":"13160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Sesamoid Bone","code_information":[{"code":"2202649","type":"CDM"},{"code":"360","type":"RC"},{"code":"28315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Skn Splt A-grft Fac/nck/hf/g","code_information":[{"code":"2202677","type":"CDM"},{"code":"360","type":"RC"},{"code":"15120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Splitthickness Autograft Trunk Arms Legs","code_information":[{"code":"2202679","type":"CDM"},{"code":"360","type":"RC"},{"code":"15101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Resect Inferior Turbinate","code_information":[{"code":"2202685","type":"CDM"},{"code":"360","type":"RC"},{"code":"30140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Suction Assisted Lipectomy Head & Neck","code_information":[{"code":"2202687","type":"CDM"},{"code":"360","type":"RC"},{"code":"15876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Suction Lipectomy Lwr Extrem","code_information":[{"code":"2202689","type":"CDM"},{"code":"360","type":"RC"},{"code":"15879","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Suction Assisted Lipectomy Trunk","code_information":[{"code":"2202691","type":"CDM"},{"code":"360","type":"RC"},{"code":"15877","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Suction Lipectomy Upr Extrem","code_information":[{"code":"2202693","type":"CDM"},{"code":"360","type":"RC"},{"code":"15878","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Anal Fist Complex","code_information":[{"code":"2202703","type":"CDM"},{"code":"360","type":"RC"},{"code":"46280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Anal Fist 2 Stage","code_information":[{"code":"2202705","type":"CDM"},{"code":"360","type":"RC"},{"code":"46285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Anal Fist Subq","code_information":[{"code":"2202707","type":"CDM"},{"code":"360","type":"RC"},{"code":"46270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Anal Fist Inter","code_information":[{"code":"2202709","type":"CDM"},{"code":"360","type":"RC"},{"code":"46275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treat Ectopic Pregnancy","code_information":[{"code":"2202711","type":"CDM"},{"code":"360","type":"RC"},{"code":"59120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Digit Nerve","code_information":[{"code":"2202715","type":"CDM"},{"code":"360","type":"RC"},{"code":"64831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Suture Infrapatellar Tendon Primary","code_information":[{"code":"2202717","type":"CDM"},{"code":"360","type":"RC"},{"code":"27380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Thigh Muscle","code_information":[{"code":"2202725","type":"CDM"},{"code":"360","type":"RC"},{"code":"27385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incise Finger Tendon Sheath","code_information":[{"code":"2202737","type":"CDM"},{"code":"360","type":"RC"},{"code":"26055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Transplant Forearm Tendon","code_information":[{"code":"2202739","type":"CDM"},{"code":"360","type":"RC"},{"code":"25310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Tenodesis Long Tendon Biceps","code_information":[{"code":"2202743","type":"CDM"},{"code":"360","type":"RC"},{"code":"23430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Release Hand/finger Tendon","code_information":[{"code":"2202745","type":"CDM"},{"code":"360","type":"RC"},{"code":"26445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Release Of Lower Leg Tendon","code_information":[{"code":"2202749","type":"CDM"},{"code":"360","type":"RC"},{"code":"27680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Tenolysis Flexor Foot Single Tendon","code_information":[{"code":"2202753","type":"CDM"},{"code":"360","type":"RC"},{"code":"28220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Hip Tendons","code_information":[{"code":"2202755","type":"CDM"},{"code":"360","type":"RC"},{"code":"27006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Hip Tendon","code_information":[{"code":"2202757","type":"CDM"},{"code":"360","type":"RC"},{"code":"27000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Elbow Perc","code_information":[{"code":"2202762","type":"CDM"},{"code":"360","type":"RC"},{"code":"24357","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Foot Tendon","code_information":[{"code":"2202768","type":"CDM"},{"code":"360","type":"RC"},{"code":"28234","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Thigh Tendon","code_information":[{"code":"2202771","type":"CDM"},{"code":"360","type":"RC"},{"code":"27390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Foot Tendon(s)","code_information":[{"code":"2202773","type":"CDM"},{"code":"360","type":"RC"},{"code":"28230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Achilles Tendon","code_information":[{"code":"2202777","type":"CDM"},{"code":"360","type":"RC"},{"code":"27606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Achilles Tendon","code_information":[{"code":"2202779","type":"CDM"},{"code":"360","type":"RC"},{"code":"27605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Thigh Tendons","code_information":[{"code":"2202781","type":"CDM"},{"code":"360","type":"RC"},{"code":"27307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Incision Of Thigh Tendon","code_information":[{"code":"2202783","type":"CDM"},{"code":"360","type":"RC"},{"code":"27306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Tenotomy Shoulder Area Single Tendon","code_information":[{"code":"2202785","type":"CDM"},{"code":"360","type":"RC"},{"code":"23405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repeat Thyroid Surgery","code_information":[{"code":"2202791","type":"CDM"},{"code":"360","type":"RC"},{"code":"60260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Thyroidectomy Total Or Complete","code_information":[{"code":"2202793","type":"CDM"},{"code":"360","type":"RC"},{"code":"60240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Thyroid","code_information":[{"code":"2202795","type":"CDM"},{"code":"360","type":"RC"},{"code":"60252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Tonsils And Adenoids","code_information":[{"code":"2202801","type":"CDM"},{"code":"360","type":"RC"},{"code":"42821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal of tonsils and adenoid glands, patient younger than age 12","code_information":[{"code":"2202803","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"42820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Tonsils","code_information":[{"code":"2202805","type":"CDM"},{"code":"360","type":"RC"},{"code":"42826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Removal Of Tonsils","code_information":[{"code":"2202807","type":"CDM"},{"code":"360","type":"RC"},{"code":"42825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Partial Removal Of Thyroid","code_information":[{"code":"2202819","type":"CDM"},{"code":"360","type":"RC"},{"code":"60220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Lower Leg Tendon","code_information":[{"code":"2202826","type":"CDM"},{"code":"360","type":"RC"},{"code":"27691","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Lower Leg Tendon","code_information":[{"code":"2202830","type":"CDM"},{"code":"360","type":"RC"},{"code":"27690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Transplant Hand Tendon","code_information":[{"code":"2202832","type":"CDM"},{"code":"360","type":"RC"},{"code":"26480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Remove Prostate Regrowth","code_information":[{"code":"2202843","type":"CDM"},{"code":"360","type":"RC"},{"code":"52630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1058,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Treatment Of Tibia Fracture","code_information":[{"code":"2202861","type":"CDM"},{"code":"360","type":"RC"},{"code":"27759","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1508,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Of Eardrum","code_information":[{"code":"2202863","type":"CDM"},{"code":"360","type":"RC"},{"code":"69610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Eardrum Structures","code_information":[{"code":"2202865","type":"CDM"},{"code":"360","type":"RC"},{"code":"69635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Middle Ear & Mastoid","code_information":[{"code":"2202867","type":"CDM"},{"code":"360","type":"RC"},{"code":"69645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Revise Middle Ear & Mastoid","code_information":[{"code":"2202871","type":"CDM"},{"code":"360","type":"RC"},{"code":"69641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":2196,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Repair Eardrum Structures","code_information":[{"code":"2202873","type":"CDM"},{"code":"360","type":"RC"},{"code":"69631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Perc Lumbar Intravertebral Disc Inj Proc","code_information":[{"code":"2202879","type":"CDM"},{"code":"360","type":"RC"},{"code":"0627T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Unlisted Hysteroscopy Procedure Uterus","code_information":[{"code":"2202881","type":"CDM"},{"code":"360","type":"RC"},{"code":"58579","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparo Proc Abdm/per/oment","code_information":[{"code":"2202885","type":"CDM"},{"code":"360","type":"RC"},{"code":"49329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Procedure Bladder","code_information":[{"code":"2202889","type":"CDM"},{"code":"360","type":"RC"},{"code":"51999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscope Proc Intestine","code_information":[{"code":"2202893","type":"CDM"},{"code":"360","type":"RC"},{"code":"44238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Laparoscopy Procedure Stomach","code_information":[{"code":"2202897","type":"CDM"},{"code":"360","type":"RC"},{"code":"43659","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1232,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Arthroscopy","code_information":[{"code":"2202902","type":"CDM"},{"code":"360","type":"RC"},{"code":"29999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Esophagus","code_information":[{"code":"2202906","type":"CDM"},{"code":"360","type":"RC"},{"code":"43499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Foot Or Toes","code_information":[{"code":"2202912","type":"CDM"},{"code":"360","type":"RC"},{"code":"28899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Humerus Or Elbow","code_information":[{"code":"2202916","type":"CDM"},{"code":"360","type":"RC"},{"code":"24999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Leg Or Ankle","code_information":[{"code":"2202918","type":"CDM"},{"code":"360","type":"RC"},{"code":"27899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Middle Ear","code_information":[{"code":"2202922","type":"CDM"},{"code":"360","type":"RC"},{"code":"69799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Nose","code_information":[{"code":"2202926","type":"CDM"},{"code":"360","type":"RC"},{"code":"30999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Throat Surgery Procedure","code_information":[{"code":"2202928","type":"CDM"},{"code":"360","type":"RC"},{"code":"42999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Shoulder","code_information":[{"code":"2202930","type":"CDM"},{"code":"360","type":"RC"},{"code":"23929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Procedure Urinary System","code_information":[{"code":"2202936","type":"CDM"},{"code":"360","type":"RC"},{"code":"53899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Vag Hyst Including T/o","code_information":[{"code":"2202954","type":"CDM"},{"code":"360","type":"RC"},{"code":"58262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":1665,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Vasovasostomy Vasovasorrhaphy","code_information":[{"code":"2202960","type":"CDM"},{"code":"360","type":"RC"},{"code":"55400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":924,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Or Level 3 Each Add'l Min","code_information":[{"code":"2202983","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202983","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":176,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Antihuman Globulin Direct Ea Antiserum","code_information":[{"code":"4000054","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":175,"gross_charge":219,"discounted_cash":219,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":175}]}]},{"description":"Coombs Test Direct","code_information":[{"code":"8400700","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":175,"gross_charge":219,"discounted_cash":219,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":175}]}]},{"description":"Sumatriptan Succinate 6mg/0.5ml","code_information":[{"code":"3000292","type":"CDM"},{"code":"636","type":"RC"},{"code":"55150017305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":174,"maximum":174,"gross_charge":218,"discounted_cash":218,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Destruct Benign Lesion 1-14","code_information":[{"code":"8500136","type":"CDM"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":924,"gross_charge":218,"discounted_cash":218,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Injection Intramuscular Or Subcutaneous","code_information":[{"code":"8400389","type":"CDM"},{"code":"450","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":195,"gross_charge":217,"discounted_cash":217,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Antibody Hiv2","code_information":[{"code":"4000035","type":"CDM"},{"code":"300","type":"RC"},{"code":"86702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":174,"gross_charge":217,"discounted_cash":217,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Assay Of Ammonia","code_information":[{"code":"8400493","type":"CDM"},{"code":"300","type":"RC"},{"code":"82140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":174,"gross_charge":217,"discounted_cash":217,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Phosphatase Alkaline Isoenzymes","code_information":[{"code":"4000318","type":"CDM"},{"code":"300","type":"RC"},{"code":"84080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":174,"gross_charge":217,"discounted_cash":217,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Excision Benign Lesion Trunk Arms O","code_information":[{"code":"8500085","type":"CDM"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":924,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"Afo Multiligamentus Ankle Su","code_information":[{"code":"8401335","type":"CDM"},{"code":"450","type":"RC"},{"code":"L1906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":173,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"Tobra 0.3%/dexameth 0.1% Opth Susp 2.5ml","code_information":[{"code":"3060863","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":173,"maximum":173,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Trypsin Duodenal Fluid","code_information":[{"code":"4000377","type":"CDM"},{"code":"300","type":"RC"},{"code":"84485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":172,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Trypsin Duodenal Fluid","code_information":[{"code":"8400595","type":"CDM"},{"code":"300","type":"RC"},{"code":"84485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":172,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Puncture Asp Abscess Hematoma Bulla/cyst","code_information":[{"code":"8500075","type":"CDM"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":924,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Inf Agent Det Hepatitis G","code_information":[{"code":"4000231","type":"CDM"},{"code":"300","type":"RC"},{"code":"87525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":172,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Hepatitis G Dna Dir Probe","code_information":[{"code":"8400759","type":"CDM"},{"code":"300","type":"RC"},{"code":"87525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":172,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Anti Tpo Ab","code_information":[{"code":"8400643","type":"CDM"},{"code":"300","type":"RC"},{"code":"86376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":171,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171}]}]},{"description":"Abo And Rh Blood Typing","code_information":[{"code":"8400270","type":"CDM"},{"code":"450","type":"RC"},{"code":"3293F","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":171,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171}]}]},{"description":"Incision&removal Fb Subq Tiss Smpl","code_information":[{"code":"8500072","type":"CDM"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":924,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171}]}]},{"description":"Serial Tonometry Exam","code_information":[{"code":"8400356","type":"CDM"},{"code":"450","type":"RC"},{"code":"92100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":171,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171}]}]},{"description":"Copper","code_information":[{"code":"4000097","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":170,"gross_charge":213,"discounted_cash":213,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Eye Exam New Patient","code_information":[{"code":"8400355","type":"CDM"},{"code":"450","type":"RC"},{"code":"92002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":170,"gross_charge":213,"discounted_cash":213,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Catheter Set Cvc 7.5 Fr. 2 Lumen","code_information":[{"code":"8401228","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CCAT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CCAT"],"minimum":170,"maximum":170,"gross_charge":213,"discounted_cash":213,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Cath Kit Cvc 7 Fr. 3 Lumen","code_information":[{"code":"8401229","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CCAT2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CCAT2"],"minimum":170,"maximum":170,"gross_charge":213,"discounted_cash":213,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Hepatitis A Antibody Haab Total","code_information":[{"code":"4000175","type":"CDM"},{"code":"300","type":"RC"},{"code":"86708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":170,"gross_charge":213,"discounted_cash":213,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"4000275","type":"CDM"},{"code":"301","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":170,"gross_charge":212,"discounted_cash":212,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"8400628","type":"CDM"},{"code":"301","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":170,"gross_charge":212,"discounted_cash":212,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Cardizem/diltiazem 25mg/5ml Vial Iv","code_information":[{"code":"8400976","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":169,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Zithromax Azithromycin Dihydrate=<1 Gm","code_information":[{"code":"8401099","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q0144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":169,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Inf Agent Antigen Detection Giardia","code_information":[{"code":"4000199","type":"CDM"},{"code":"300","type":"RC"},{"code":"87329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":169,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Inf Agent Antigen Detection Hep B","code_information":[{"code":"4000200","type":"CDM"},{"code":"300","type":"RC"},{"code":"87340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":169,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Inf Agent Antigen Hep B","code_information":[{"code":"4000201","type":"CDM"},{"code":"300","type":"RC"},{"code":"87350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":169,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Giardia Ag Eia","code_information":[{"code":"8400737","type":"CDM"},{"code":"300","type":"RC"},{"code":"87329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":169,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Hepatitis B Surface Ag Eia","code_information":[{"code":"8400738","type":"CDM"},{"code":"300","type":"RC"},{"code":"87340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":169,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Infectious Agent Antigen Detection","code_information":[{"code":"8400739","type":"CDM"},{"code":"300","type":"RC"},{"code":"87350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":169,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Mononuclear Cell Antigen Quantitative","code_information":[{"code":"4000299","type":"CDM"},{"code":"300","type":"RC"},{"code":"86356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Mononuclear Cell Antigen Quantit Nos Ea","code_information":[{"code":"8400642","type":"CDM"},{"code":"300","type":"RC"},{"code":"86356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Fibrinogen Antigen","code_information":[{"code":"4000146","type":"CDM"},{"code":"300","type":"RC"},{"code":"85385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Fibrinogen Antigen","code_information":[{"code":"8400621","type":"CDM"},{"code":"300","type":"RC"},{"code":"85385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Thyroxine Total","code_information":[{"code":"4000364","type":"CDM"},{"code":"300","type":"RC"},{"code":"84436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Virus Isolation Including Id By Nonimm","code_information":[{"code":"4000390","type":"CDM"},{"code":"300","type":"RC"},{"code":"87255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Thyroid Panel","code_information":[{"code":"8400582","type":"CDM"},{"code":"300","type":"RC"},{"code":"84436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Genet Virus Isolate Hsv","code_information":[{"code":"8400729","type":"CDM"},{"code":"300","type":"RC"},{"code":"87255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Inf Agent Detect Na Sars Coronoavirus 2","code_information":[{"code":"8400769","type":"CDM"},{"code":"300","type":"RC"},{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Level I Pathology Gross Examination Only","code_information":[{"code":"4000285","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Iron Binding Capacity","code_information":[{"code":"4000251","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Thyroxine Free","code_information":[{"code":"4000363","type":"CDM"},{"code":"300","type":"RC"},{"code":"84439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Iron Bndng Cap","code_information":[{"code":"8400550","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Thyroxine Fr","code_information":[{"code":"8400583","type":"CDM"},{"code":"300","type":"RC"},{"code":"84439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":168,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Removal Of Sutures","code_information":[{"code":"1000217","type":"CDM"},{"code":"450","type":"RC"},{"code":"S0630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":167,"gross_charge":209,"discounted_cash":209,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":167}]}]},{"description":"Removal Of Sutures","code_information":[{"code":"8400435","type":"CDM"},{"code":"450","type":"RC"},{"code":"S0630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":167,"gross_charge":209,"discounted_cash":209,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":167}]}]},{"description":"Tuberculosis Test Cell Mediated","code_information":[{"code":"4000378","type":"CDM"},{"code":"300","type":"RC"},{"code":"86481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Tuberculosis Test Cell Mediated Immunity","code_information":[{"code":"4000379","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Triiodothyro9 T3 Tot","code_information":[{"code":"8400591","type":"CDM"},{"code":"300","type":"RC"},{"code":"84480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Tb Cell Mediatd Antgn Respns Gamma Inter","code_information":[{"code":"8400649","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Tb Ag Response T-cell Susp","code_information":[{"code":"8400650","type":"CDM"},{"code":"300","type":"RC"},{"code":"86481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Hepatitis A Antibody Haab Igm Antibody","code_information":[{"code":"4000174","type":"CDM"},{"code":"300","type":"RC"},{"code":"86709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Hepatitis A Total Antibody","code_information":[{"code":"8400676","type":"CDM"},{"code":"300","type":"RC"},{"code":"86708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Hepatitis A Antibody Haab","code_information":[{"code":"8400677","type":"CDM"},{"code":"300","type":"RC"},{"code":"86709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Sptm Obtg Spec Aersl Induced Spx","code_information":[{"code":"8400793","type":"CDM"},{"code":"300","type":"RC"},{"code":"89220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Antinuclear Antibodies Ana","code_information":[{"code":"4000055","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Inhalation Treatmentcontinuous 1st Hr","code_information":[{"code":"8400378","type":"CDM"},{"code":"410","type":"RC"},{"code":"94644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":210,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Alcohol Ethanol Breath","code_information":[{"code":"4000006","type":"CDM"},{"code":"300","type":"RC"},{"code":"82075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Magnesium","code_information":[{"code":"4000297","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Magnesium","code_information":[{"code":"8400556","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Inf Agent Detection By Nucleic Acid","code_information":[{"code":"4000219","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Virus Inoculation Tissue","code_information":[{"code":"8400728","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Detect Agent Nos Dna Amp","code_information":[{"code":"8400774","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":166,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Lactate Dehydrogenase Ld Ldh","code_information":[{"code":"4000281","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":165,"maximum":165,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165}]}]},{"description":"Inf Agent Antigen Rsv","code_information":[{"code":"4000204","type":"CDM"},{"code":"300","type":"RC"},{"code":"87420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":165,"maximum":165,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165}]}]},{"description":"Infect Agent Streptococcus Group A","code_information":[{"code":"4000272","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":165,"maximum":165,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165}]}]},{"description":"Fine Needle Aspiration With Imaging Guid","code_information":[{"code":"8500067","type":"CDM"},{"code":"10022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":164,"gross_charge":205,"discounted_cash":205,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":164}]}]},{"description":"Triglycerides","code_information":[{"code":"8400589","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":162,"gross_charge":203,"discounted_cash":203,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Dipropylacetic Acid","code_information":[{"code":"8400461","type":"CDM"},{"code":"300","type":"RC"},{"code":"80164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":162,"gross_charge":203,"discounted_cash":203,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Troponin Qualitative","code_information":[{"code":"4000376","type":"CDM"},{"code":"300","type":"RC"},{"code":"84512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":162,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Troponin Qual","code_information":[{"code":"8400596","type":"CDM"},{"code":"300","type":"RC"},{"code":"84512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":162,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Should Sling/vest/abrestrain","code_information":[{"code":"8401205","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":162,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Vitamin D 25 Hydroxy","code_information":[{"code":"8400503","type":"CDM"},{"code":"300","type":"RC"},{"code":"82306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":162,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Cult Bact Quant Aerobic W/ Isolation","code_information":[{"code":"8400711","type":"CDM"},{"code":"300","type":"RC"},{"code":"87071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":161,"gross_charge":201,"discounted_cash":201,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":161}]}]},{"description":"Assay Of Parathormone","code_information":[{"code":"8400562","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":161,"gross_charge":201,"discounted_cash":201,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":161}]}]},{"description":"Iron","code_information":[{"code":"4000250","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":161,"gross_charge":201,"discounted_cash":201,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":161}]}]},{"description":"S&n Suture 38","code_information":[{"code":"2800786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":161,"gross_charge":201,"discounted_cash":201,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":161}]}]},{"description":"Control Nasal Hemorrhage Anterior Simple","code_information":[{"code":"8400258","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":924,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Collect Blood From Implant Ven Acc Dvc","code_information":[{"code":"8400278","type":"CDM"},{"code":"940","type":"RC"},{"code":"36591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":300,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Arthrex .062 Guidewire 6","code_information":[{"code":"2800748","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Arthrex .062 Guidewire 7","code_information":[{"code":"2800749","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Injection Regadenoson .1mg","code_information":[{"code":"3061739","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Astreneca Admin","code_information":[{"code":"5000022","type":"CDM"},{"code":"771","type":"RC"},{"code":"0021A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Atreneca Admin 3","code_information":[{"code":"5000023","type":"CDM"},{"code":"771","type":"RC"},{"code":"0022A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Johnson Admin 2","code_information":[{"code":"5000099","type":"CDM"},{"code":"771","type":"RC"},{"code":"0031A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Moderna Admin 2","code_information":[{"code":"5000112","type":"CDM"},{"code":"771","type":"RC"},{"code":"0011A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Moderna Admin 3","code_information":[{"code":"5000113","type":"CDM"},{"code":"771","type":"RC"},{"code":"0012A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Moderna Admin 4","code_information":[{"code":"5000114","type":"CDM"},{"code":"771","type":"RC"},{"code":"0013A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Pfizer Admin 1","code_information":[{"code":"5000134","type":"CDM"},{"code":"771","type":"RC"},{"code":"0001A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Pfizer Admin 2","code_information":[{"code":"5000135","type":"CDM"},{"code":"771","type":"RC"},{"code":"0002A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Pfizer Admin 3","code_information":[{"code":"5000136","type":"CDM"},{"code":"771","type":"RC"},{"code":"0003A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Sars-cov2 Antibody Quantitative","code_information":[{"code":"8400646","type":"CDM"},{"code":"300","type":"RC"},{"code":"86413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Adm Sarscov2 30 Mcg/0.3 Ml 1st Ds Pfizer","code_information":[{"code":"8400810","type":"CDM"},{"code":"250","type":"RC"},{"code":"0001A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Adm Sarscov2 30 Mcg/0.3 Ml 2nd Ds Pfizer","code_information":[{"code":"8400811","type":"CDM"},{"code":"250","type":"RC"},{"code":"0002A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Adm Sarscov2 30 Mcg/0.3 Ml 2nd Ds Pfizer","code_information":[{"code":"8400812","type":"CDM"},{"code":"250","type":"RC"},{"code":"0003A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Adm Sarscov2 100 Mcg/0.5ml 1st Ds Modrna","code_information":[{"code":"8400813","type":"CDM"},{"code":"250","type":"RC"},{"code":"0011A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Adm Sarscov2 100 Mcg/0.5ml 2nd Ds Modrna","code_information":[{"code":"8400814","type":"CDM"},{"code":"250","type":"RC"},{"code":"0012A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Adm Sarscov2 100 Mcg/0.5ml 3rd Ds Modrna","code_information":[{"code":"8400815","type":"CDM"},{"code":"250","type":"RC"},{"code":"0013A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Adm Sarscov2 5x10^10vp/.5 Ml 1st Astrznc","code_information":[{"code":"8400816","type":"CDM"},{"code":"250","type":"RC"},{"code":"0021A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Adm Sarscov2 Vac As26 .5ml 1st Dose J&j","code_information":[{"code":"8400818","type":"CDM"},{"code":"250","type":"RC"},{"code":"0031A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Blood Count Manual Cell Count","code_information":[{"code":"4000068","type":"CDM"},{"code":"300","type":"RC"},{"code":"85032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Bld# Mnl C-cnt Rbc Wbc/pltlt Ea","code_information":[{"code":"8400610","type":"CDM"},{"code":"300","type":"RC"},{"code":"85032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Assay Of Iron","code_information":[{"code":"8400549","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":160,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Occult Blood Feces","code_information":[{"code":"4000079","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":159,"maximum":159,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":159}]}]},{"description":"Bld Oclt Proxidase Actv Qual Feces 1 Dtr","code_information":[{"code":"8400499","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":159,"maximum":159,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":159}]}]},{"description":"Tetanus And Diptheria Toxoids 7 Yr/> Im","code_information":[{"code":"8400836","type":"CDM"},{"code":"250","type":"RC"},{"code":"90718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":159,"maximum":159,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":159}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Evacuation Subungual Hematoma","code_information":[{"code":"8500090","type":"CDM"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":924,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Lyme Disease Antibody","code_information":[{"code":"8400656","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":158,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Code Added To Mtch Pay Master7.25.2016lt","code_information":[{"code":"8400788","type":"CDM"},{"code":"300","type":"RC"},{"code":"88618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":158,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Hepatitis Be Antibody Hbeab","code_information":[{"code":"4000180","type":"CDM"},{"code":"300","type":"RC"},{"code":"86707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":158,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Hepatitis Be Antibody","code_information":[{"code":"8400675","type":"CDM"},{"code":"300","type":"RC"},{"code":"86707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":158,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Tte For Congenital Cardiac Anomalies Cmp","code_information":[{"code":"8500367","type":"CDM"},{"code":"93303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Uric Acid Bld","code_information":[{"code":"8400598","type":"CDM"},{"code":"300","type":"RC"},{"code":"84550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":158,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Fibrin Degradation Products Ddimer","code_information":[{"code":"4000143","type":"CDM"},{"code":"300","type":"RC"},{"code":"85378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":158,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Ekg W/least 12 Lds Reading Only","code_information":[{"code":"8400362","type":"CDM"},{"code":"93010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"D-dimer","code_information":[{"code":"8400617","type":"CDM"},{"code":"300","type":"RC"},{"code":"85378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":158,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Phenobarbital","code_information":[{"code":"4000313","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":158,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Triamcinalone Preser Free 40mg/ml 1ml","code_information":[{"code":"3000303","type":"CDM"},{"code":"636","type":"RC"},{"code":"30293","type":"CPT","modifier":"20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["20"],"minimum":158,"maximum":158,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Direct Admission Pt For Hosp Obs Care","code_information":[{"code":"100001","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":2800,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2800}]}]},{"description":"Insulin Total","code_information":[{"code":"4000249","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":157,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Transferase Aspartate Amino Ast Sgot","code_information":[{"code":"4000370","type":"CDM"},{"code":"300","type":"RC"},{"code":"84450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":157,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Transferase Aspartate Amino","code_information":[{"code":"8400586","type":"CDM"},{"code":"300","type":"RC"},{"code":"84450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":157,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Inf Agent Antigen Detection","code_information":[{"code":"4000195","type":"CDM"},{"code":"300","type":"RC"},{"code":"87389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":157,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Hiv-1 Ag W/hiv-1 & Hiv-2 Ab","code_information":[{"code":"8400740","type":"CDM"},{"code":"300","type":"RC"},{"code":"87389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":157,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Hiv-1 Ag Eia","code_information":[{"code":"8400741","type":"CDM"},{"code":"300","type":"RC"},{"code":"87390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":157,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Acetone/other Ketone Bodies Serum Qualit","code_information":[{"code":"4000001","type":"CDM"},{"code":"300","type":"RC"},{"code":"82009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":157,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Eval Cvs Fct W/tlt Tbl Evl W/cnt Ecg Mtr","code_information":[{"code":"8500373","type":"CDM"},{"code":"93660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":275,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Kenalog 40 40mg/ml 1ml Vial","code_information":[{"code":"3000132","type":"CDM"},{"code":"636","type":"RC"},{"code":"16714013025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":156,"maximum":156,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Kenalog 40 40mg/ml Mdv 5ml","code_information":[{"code":"3060845","type":"CDM"},{"code":"636","type":"RC"},{"code":"30293","type":"CPT","modifier":"20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["20"],"minimum":156,"maximum":156,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Synthes 3.9mm X 45mm Cotex Screw","code_information":[{"code":"2800609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":156,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"Consultation Xr Examination","code_information":[{"code":"5000055","type":"CDM"},{"code":"940","type":"RC"},{"code":"76140","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":156,"maximum":300,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Creatinine Clearance","code_information":[{"code":"4000107","type":"CDM"},{"code":"300","type":"RC"},{"code":"82575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":156,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"Enzyme Activity In Blood Cells","code_information":[{"code":"4000139","type":"CDM"},{"code":"300","type":"RC"},{"code":"82657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Nzm Actv Cells/tiss Nonradact Substrate","code_information":[{"code":"8400524","type":"CDM"},{"code":"300","type":"RC"},{"code":"82657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Complete blood cell count (CBC), automated","code_information":[{"code":"4000065","type":"CDM"},{"code":"301","type":"RC"},{"code":"85027","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Complete blood cell count (CBC), automated","code_information":[{"code":"8400609","type":"CDM"},{"code":"301","type":"RC"},{"code":"85027","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Blood Typing Antigen Screening","code_information":[{"code":"4000074","type":"CDM"},{"code":"300","type":"RC"},{"code":"86904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Blood Typing Rh Phenotyping Complete","code_information":[{"code":"4000076","type":"CDM"},{"code":"300","type":"RC"},{"code":"86906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Culture Bacterial Quantitative Anaerobic","code_information":[{"code":"4000111","type":"CDM"},{"code":"300","type":"RC"},{"code":"87073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Blood Typing Rh (D)","code_information":[{"code":"4000256","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Sincalide Injection","code_information":[{"code":"8400947","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Lipoprotein Direct Measurement","code_information":[{"code":"4000294","type":"CDM"},{"code":"300","type":"RC"},{"code":"83718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Lipoprotein Direct Msmt High Dens Cholst","code_information":[{"code":"8400555","type":"CDM"},{"code":"300","type":"RC"},{"code":"83718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":155,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Tdap 7 Yr/<","code_information":[{"code":"8400835","type":"CDM"},{"code":"250","type":"RC"},{"code":"90715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":154,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Removal Skin Tag Mlt Fibrocutaneous Tag","code_information":[{"code":"8500084","type":"CDM"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":924,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154}]}]},{"description":"Vasopneumatic Device Therapy","code_information":[{"code":"6100005","type":"CDM"},{"code":"420","type":"RC"},{"code":"97016","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":154,"maximum":225,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Albuterol Neb 2.5mg/3ml","code_information":[{"code":"3000009","type":"CDM"},{"code":"636","type":"RC"},{"code":"48795","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Creatinine; Blood","code_information":[{"code":"4000261","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Lipase","code_information":[{"code":"4000292","type":"CDM"},{"code":"300","type":"RC"},{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"4000337","type":"CDM"},{"code":"301","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Sedimentation Rate Erythrocyte Nonautoma","code_information":[{"code":"4000338","type":"CDM"},{"code":"300","type":"RC"},{"code":"85651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Rhythm Ecg One To Three Leads Tracing","code_information":[{"code":"4200017","type":"CDM"},{"code":"730","type":"RC"},{"code":"93041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Rhythm Ecg 1-3 Lds Trcg Only W/o I&r","code_information":[{"code":"8400364","type":"CDM"},{"code":"450","type":"RC"},{"code":"93041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Creatinine Bld","code_information":[{"code":"8400521","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Lipase","code_information":[{"code":"8400554","type":"CDM"},{"code":"300","type":"RC"},{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Sedimentation Rate Rbc Non-auto","code_information":[{"code":"8400625","type":"CDM"},{"code":"300","type":"RC"},{"code":"85651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Albuterol Comp Unit","code_information":[{"code":"8401035","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Slings","code_information":[{"code":"8401204","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Visual Acuity Screening","code_information":[{"code":"8500411","type":"CDM"},{"code":"99173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Ankle Foot Orthosis","code_information":[{"code":"8401334","type":"CDM"},{"code":"450","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":153,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Avulsion Nail Plate Partial Comp Simp 1","code_information":[{"code":"8500088","type":"CDM"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":924,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Inf Agent Antigen Cryptococcus Neoforman","code_information":[{"code":"4000198","type":"CDM"},{"code":"300","type":"RC"},{"code":"87327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Cryptococcus Neoform Ag Eia","code_information":[{"code":"8400736","type":"CDM"},{"code":"300","type":"RC"},{"code":"87327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Chylmd Trach Dna Quant","code_information":[{"code":"8400752","type":"CDM"},{"code":"300","type":"RC"},{"code":"87492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Calcium Gluconate Injection","code_information":[{"code":"8400871","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Calcium Gluconate Injection","code_information":[{"code":"8401528","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"10% Calcium Gluconate 100mg/ml 10ml","code_information":[{"code":"3000039","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Vent Tube Good T","code_information":[{"code":"2800689","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Physical Therapy Reevaluation","code_information":[{"code":"6100014","type":"CDM"},{"code":"424","type":"RC"},{"code":"97002","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":152,"maximum":225,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Antibody Hiv1","code_information":[{"code":"4000033","type":"CDM"},{"code":"300","type":"RC"},{"code":"86701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Antb Hiv-1","code_information":[{"code":"8400670","type":"CDM"},{"code":"300","type":"RC"},{"code":"86701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":152,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Tee R-t Img 2d Img Acquisj I&r Only","code_information":[{"code":"8500370","type":"CDM"},{"code":"93314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Hemoglobin Glycosylated A1c","code_information":[{"code":"4000172","type":"CDM"},{"code":"300","type":"RC"},{"code":"83036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":151,"maximum":151,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"I&d Of Bartholin`s Gland Absc","code_information":[{"code":"8500312","type":"CDM"},{"code":"56420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":151,"maximum":924,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"Tetanus And Diptheria Toxoids 7 Yr/> Im","code_information":[{"code":"8400834","type":"CDM"},{"code":"250","type":"RC"},{"code":"90714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Immunoassay Analyte Quantitative Nos","code_information":[{"code":"8400547","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Insulin Total","code_information":[{"code":"8400548","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Antb Inf Virus","code_information":[{"code":"8400678","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Rsv Antb","code_information":[{"code":"8400683","type":"CDM"},{"code":"300","type":"RC"},{"code":"86756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Iaadiadoo Streptococcus Grp","code_information":[{"code":"8400783","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Ciprofloxacin Iv","code_information":[{"code":"8400879","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Ctl Medical Set Screw","code_information":[{"code":"2800152","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Picasso Ii Set Screw","code_information":[{"code":"2800359","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Inhalation Tx W/aerosol Med Each Hour","code_information":[{"code":"6400001","type":"CDM"},{"code":"410","type":"RC"},{"code":"94645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":210,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Moderate Sedation Same Phys Qhp > 5 Yrs","code_information":[{"code":"8500406","type":"CDM"},{"code":"99152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":150,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Wear Ecg24hr W/vis Supimpos Scn Phys R&i","code_information":[{"code":"8500366","type":"CDM"},{"code":"93224","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Bld Typing Abo","code_information":[{"code":"8400701","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":149,"gross_charge":186,"discounted_cash":186,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"Flow Cytometry Cell 1st Marker","code_information":[{"code":"4000148","type":"CDM"},{"code":"310","type":"RC"},{"code":"88184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":148,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"Carbamide/ Ear Drp Otic","code_information":[{"code":"8401063","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":148,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":148}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"H Pylori Blood Helicobacter Pylori","code_information":[{"code":"8400543","type":"CDM"},{"code":"300","type":"RC"},{"code":"83009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":148,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"Inf Agent Det Dna Or Rna N Gonorrhoeae","code_information":[{"code":"4000239","type":"CDM"},{"code":"300","type":"RC"},{"code":"87592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":147,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Ipecac/similar Adm Emesis&obs Stmch Empt","code_information":[{"code":"8400412","type":"CDM"},{"code":"450","type":"RC"},{"code":"99175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":147,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Iadna Neisseria Gonorrhoeae Quan","code_information":[{"code":"8400767","type":"CDM"},{"code":"300","type":"RC"},{"code":"87592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":147,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Metronidazole/tab 500mg","code_information":[{"code":"8401077","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":147,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":147}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Antibody Helicobacter Pylori","code_information":[{"code":"4000029","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":146,"gross_charge":183,"discounted_cash":183,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146}]}]},{"description":"Temporary Transcutaneous Pacing","code_information":[{"code":"1000274","type":"CDM"},{"code":"450","type":"RC"},{"code":"92953","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":146,"gross_charge":182,"discounted_cash":182,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146}]}]},{"description":"Heterophile Antibodies Screening","code_information":[{"code":"4000270","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":146,"gross_charge":182,"discounted_cash":182,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"8400572","type":"CDM"},{"code":"301","type":"RC"},{"code":"84153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":145,"gross_charge":181,"discounted_cash":181,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"8400573","type":"CDM"},{"code":"301","type":"RC"},{"code":"84154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":145,"gross_charge":181,"discounted_cash":181,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Remove Foreign Body From Eye","code_information":[{"code":"8500335","type":"CDM"},{"code":"65210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":145,"gross_charge":181,"discounted_cash":181,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Inf Agent Det Dna Or Rna Chl Trachomatis","code_information":[{"code":"4000222","type":"CDM"},{"code":"300","type":"RC"},{"code":"87491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":145,"gross_charge":181,"discounted_cash":181,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Chlamydia Trachomatis Amp Probe Tech","code_information":[{"code":"8400751","type":"CDM"},{"code":"300","type":"RC"},{"code":"87491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":145,"gross_charge":181,"discounted_cash":181,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Inf Agent Antigen C Difficile Toxin A","code_information":[{"code":"4000208","type":"CDM"},{"code":"300","type":"RC"},{"code":"87803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":144,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Clostridium Toxin A W/optic","code_information":[{"code":"8400777","type":"CDM"},{"code":"300","type":"RC"},{"code":"87803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":144,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Inf Agent Det Dna Or Rna Candida Species","code_information":[{"code":"4000220","type":"CDM"},{"code":"300","type":"RC"},{"code":"87480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":144,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Inf Agent Det Dna/rna Chlamy Trachomatis","code_information":[{"code":"4000223","type":"CDM"},{"code":"300","type":"RC"},{"code":"87490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":144,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Chylmd Trach Dna Dir Probe","code_information":[{"code":"8400750","type":"CDM"},{"code":"300","type":"RC"},{"code":"87490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":144,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Initial Tx 1st Degree Burn Local Tx","code_information":[{"code":"8500132","type":"CDM"},{"code":"16000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":144,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Uric Acid Other Source","code_information":[{"code":"4000383","type":"CDM"},{"code":"300","type":"RC"},{"code":"84560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":144,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Uric Acid Oth Src","code_information":[{"code":"8400599","type":"CDM"},{"code":"300","type":"RC"},{"code":"84560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":144,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Extractor Katz Foreign Body","code_information":[{"code":"8401239","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"KATZ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["KATZ"],"minimum":143,"maximum":143,"gross_charge":179,"discounted_cash":179,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"Mechanical Traction Therapy","code_information":[{"code":"6100004","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":143,"maximum":225,"gross_charge":179,"discounted_cash":179,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Application Of Modality To One Or More A","code_information":[{"code":"6100051","type":"CDM"},{"code":"424","type":"RC"},{"code":"97012","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":143,"maximum":225,"gross_charge":179,"discounted_cash":179,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Application Of Modality To One Or More A","code_information":[{"code":"6100052","type":"CDM"},{"code":"424","type":"RC"},{"code":"97012","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":143,"maximum":225,"gross_charge":179,"discounted_cash":179,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Acell Burn Matrix 5x5cm Per Sq Cm","code_information":[{"code":"2800021","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":143,"gross_charge":179,"discounted_cash":179,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"Application Finger Splint Dynamic","code_information":[{"code":"8500243","type":"CDM"},{"code":"29131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":142,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Resp Ear Pulse Ox","code_information":[{"code":"6400006","type":"CDM"},{"code":"410","type":"RC"},{"code":"94760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":210,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Water Seal Drain Cntn&tub Implnt Chst Tb","code_information":[{"code":"8401312","type":"CDM"},{"code":"450","type":"RC"},{"code":"A7041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":142,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Specula Vaginal Kleenspec Medium","code_information":[{"code":"8401244","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SPEC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SPEC"],"minimum":142,"maximum":142,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Specula Vaginal Kleenspec Small","code_information":[{"code":"8401245","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SPEC2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SPEC2"],"minimum":142,"maximum":142,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Influ Vrs Vcc Trivlnt(iiv3)splt 0.5ml Im","code_information":[{"code":"8400821","type":"CDM"},{"code":"250","type":"RC"},{"code":"90658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":142,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq Sm","code_information":[{"code":"8500133","type":"CDM"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":924,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Echo Tthrc R-t2d-+m-mde Rst&strs Cnt Ecg","code_information":[{"code":"8500371","type":"CDM"},{"code":"93351","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":176,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Procalcitonin (Pct)","code_information":[{"code":"8400570","type":"CDM"},{"code":"300","type":"RC"},{"code":"84145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":141,"maximum":141,"gross_charge":176,"discounted_cash":176,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Inf Agent Det Dna Or Rna Chl Pneumoniae","code_information":[{"code":"4000221","type":"CDM"},{"code":"300","type":"RC"},{"code":"87486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Inf Agent Det Dna/rna Mycoplasma Pneumon","code_information":[{"code":"4000236","type":"CDM"},{"code":"300","type":"RC"},{"code":"87581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Inf Agent Detection By Nucleic Acid","code_information":[{"code":"8400749","type":"CDM"},{"code":"300","type":"RC"},{"code":"87486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Detect Test Mycoplasma Pneumoniae","code_information":[{"code":"8400764","type":"CDM"},{"code":"300","type":"RC"},{"code":"87581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Transferase Alanine Amino Alt Sgpt","code_information":[{"code":"4000369","type":"CDM"},{"code":"300","type":"RC"},{"code":"84460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Transferase Alanine Amino","code_information":[{"code":"8400587","type":"CDM"},{"code":"300","type":"RC"},{"code":"84460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Assay Of Free Testosterone","code_information":[{"code":"8400580","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Assay Of Total Testosterone","code_information":[{"code":"8400581","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Part Agglutination Screen Each Antibody","code_information":[{"code":"4000305","type":"CDM"},{"code":"300","type":"RC"},{"code":"86403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Wrist Hand Fing Orthosis W/o Jnt Prefab","code_information":[{"code":"8401339","type":"CDM"},{"code":"450","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Anosc Rmvl Fb","code_information":[{"code":"8500301","type":"CDM"},{"code":"46608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":924,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Part Aggluj Scr Ea Antb","code_information":[{"code":"8400644","type":"CDM"},{"code":"300","type":"RC"},{"code":"86403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Phosphorus Inorganic Phosphate","code_information":[{"code":"4000319","type":"CDM"},{"code":"300","type":"RC"},{"code":"84100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":140,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Rocephin Ceftriaxone Sodium Up To 250mg","code_information":[{"code":"8400876","type":"CDM"},{"code":"636","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139,"maximum":139,"gross_charge":174,"discounted_cash":174,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":139}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ceftriaxone (Rocephin) 1gm Vl","code_information":[{"code":"3000048","type":"CDM"},{"code":"636","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139,"maximum":139,"gross_charge":174,"discounted_cash":174,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":139}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Antibody Treponema Pallidum","code_information":[{"code":"4000049","type":"CDM"},{"code":"300","type":"RC"},{"code":"86780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Antibody Varicellazoster","code_information":[{"code":"4000050","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treponema Pallidum Antibody","code_information":[{"code":"8400690","type":"CDM"},{"code":"300","type":"RC"},{"code":"86780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Antb Varicella-zoster","code_information":[{"code":"8400691","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Electr Analysis Impl Neurostim Generator","code_information":[{"code":"2200861","type":"CDM"},{"code":"369","type":"RC"},{"code":"95972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Tis Trnfr F/c/c/m/n/a/g/h/f Add","code_information":[{"code":"2200019","type":"CDM"},{"code":"360","type":"RC"},{"code":"14040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Tis Trnfr F/c/c/m/n/a/g/h/f Add","code_information":[{"code":"2200021","type":"CDM"},{"code":"360","type":"RC"},{"code":"14041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Adjust Bone Fixation Device","code_information":[{"code":"2200029","type":"CDM"},{"code":"360","type":"RC"},{"code":"20693","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Allograft Spine Only Morselized Add 15","code_information":[{"code":"2200031","type":"CDM"},{"code":"360","type":"RC"},{"code":"20930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Allograft Spine Only Structural Add 1","code_information":[{"code":"2200033","type":"CDM"},{"code":"360","type":"RC"},{"code":"20931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Amputation Of Finger/thumb Add","code_information":[{"code":"2200039","type":"CDM"},{"code":"360","type":"RC"},{"code":"26952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Diagnostic Anoscopy Spx","code_information":[{"code":"2200057","type":"CDM"},{"code":"360","type":"RC"},{"code":"46600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Appendectomy","code_information":[{"code":"2200073","type":"CDM"},{"code":"360","type":"RC"},{"code":"44960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Apply Rem Fixation Device","code_information":[{"code":"2200081","type":"CDM"},{"code":"360","type":"RC"},{"code":"20660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Skn Sub Grft F/n/hf/g Child","code_information":[{"code":"2200089","type":"CDM"},{"code":"360","type":"RC"},{"code":"15277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Skin Sub Graft Face/nk/hf/g","code_information":[{"code":"2200091","type":"CDM"},{"code":"360","type":"RC"},{"code":"15275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Application Skin Substitute Graft","code_information":[{"code":"2200093","type":"CDM"},{"code":"360","type":"RC"},{"code":"15276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Appli Skin Subst Graft To Trunk Arms Leg","code_information":[{"code":"2200095","type":"CDM"},{"code":"360","type":"RC"},{"code":"15274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Skin Sub Grft T/arm/lg Child","code_information":[{"code":"2200097","type":"CDM"},{"code":"360","type":"RC"},{"code":"15273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Application Skin Substitute Graft","code_information":[{"code":"2200099","type":"CDM"},{"code":"360","type":"RC"},{"code":"15272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Skin Sub Graft Trnk/arm/leg","code_information":[{"code":"2200101","type":"CDM"},{"code":"360","type":"RC"},{"code":"15271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Arthroplasty Ipj W/prosthetic Ea Jnt Add","code_information":[{"code":"2200190","type":"CDM"},{"code":"360","type":"RC"},{"code":"26536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Arthroplasty Mp Joint Each Joint Add 1m","code_information":[{"code":"2200198","type":"CDM"},{"code":"360","type":"RC"},{"code":"26530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200207","type":"CDM"},{"code":"360","type":"RC"},{"code":"29851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ankle Arthroscopy/surgery","code_information":[{"code":"2200215","type":"CDM"},{"code":"360","type":"RC"},{"code":"29897","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ankle Arthroscopy/surgery","code_information":[{"code":"2200219","type":"CDM"},{"code":"360","type":"RC"},{"code":"29894","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ankle Arthroscopy/surgery","code_information":[{"code":"2200221","type":"CDM"},{"code":"360","type":"RC"},{"code":"29891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Hip Arthroscopy Dx","code_information":[{"code":"2200227","type":"CDM"},{"code":"360","type":"RC"},{"code":"29860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Knee Arthroscopy/surgery","code_information":[{"code":"2200243","type":"CDM"},{"code":"360","type":"RC"},{"code":"29876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Arthrotomy W/biopsy Mtp Joint","code_information":[{"code":"2200287","type":"CDM"},{"code":"360","type":"RC"},{"code":"28052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Arthrotomy With Meniscus Repair Knee","code_information":[{"code":"2200289","type":"CDM"},{"code":"360","type":"RC"},{"code":"27403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Explore/treat Ankle Joint","code_information":[{"code":"2200291","type":"CDM"},{"code":"360","type":"RC"},{"code":"27610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Wrist Joint Cartilage","code_information":[{"code":"2200295","type":"CDM"},{"code":"360","type":"RC"},{"code":"25107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Explore/treat Elbow Joint","code_information":[{"code":"2200297","type":"CDM"},{"code":"360","type":"RC"},{"code":"24101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Arthrotomy Elbow With Synovectomy","code_information":[{"code":"2200299","type":"CDM"},{"code":"360","type":"RC"},{"code":"24102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Arthrotomy Hip W/drainage Eg Infection","code_information":[{"code":"2200301","type":"CDM"},{"code":"360","type":"RC"},{"code":"27030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exploration Of Ankle Joint","code_information":[{"code":"2200307","type":"CDM"},{"code":"360","type":"RC"},{"code":"27612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Explore/treat Wrist Joint","code_information":[{"code":"2200315","type":"CDM"},{"code":"360","type":"RC"},{"code":"25101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Aspiration And/or Inj Ganglion Cysts","code_information":[{"code":"2200319","type":"CDM"},{"code":"360","type":"RC"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Autograft Spine Incl Harvst Of Graft A","code_information":[{"code":"2200327","type":"CDM"},{"code":"360","type":"RC"},{"code":"20936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Autograft For Spine Only Incl Harvest","code_information":[{"code":"2200329","type":"CDM"},{"code":"360","type":"RC"},{"code":"20937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Autograft Spine Incl Harvst Of Graft A","code_information":[{"code":"2200331","type":"CDM"},{"code":"360","type":"RC"},{"code":"20938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Avulsion Nail Plate Partial Or Comp","code_information":[{"code":"2200333","type":"CDM"},{"code":"360","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Breast W Plcmnt Brst Local Dvc","code_information":[{"code":"2200340","type":"CDM"},{"code":"360","type":"RC"},{"code":"19083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy External Auditory Canal","code_information":[{"code":"2200342","type":"CDM"},{"code":"360","type":"RC"},{"code":"69105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Breast Open Incisional","code_information":[{"code":"2200346","type":"CDM"},{"code":"360","type":"RC"},{"code":"19101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Breast Percutaneous Needle Core","code_information":[{"code":"2200348","type":"CDM"},{"code":"360","type":"RC"},{"code":"19100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Liver Needle","code_information":[{"code":"2200350","type":"CDM"},{"code":"360","type":"RC"},{"code":"47001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Penis Separate Procedure","code_information":[{"code":"2200358","type":"CDM"},{"code":"360","type":"RC"},{"code":"54100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Tongue Anterior Two-thirds","code_information":[{"code":"2200360","type":"CDM"},{"code":"360","type":"RC"},{"code":"41100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biop/exc Lymph Nodes Open Deep Axil Nd","code_information":[{"code":"2200366","type":"CDM"},{"code":"360","type":"RC"},{"code":"38525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biop/exc Lymph Nodes Open Deep Cerv Nd","code_information":[{"code":"2200368","type":"CDM"},{"code":"360","type":"RC"},{"code":"38510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy/removal Lymph Nodes","code_information":[{"code":"2200370","type":"CDM"},{"code":"360","type":"RC"},{"code":"38530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Bone Open Superficial Troch Fmr","code_information":[{"code":"2200375","type":"CDM"},{"code":"360","type":"RC"},{"code":"20240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Intranasal","code_information":[{"code":"2200379","type":"CDM"},{"code":"360","type":"RC"},{"code":"30100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Soft Tissue Neck Or Thorax","code_information":[{"code":"2200383","type":"CDM"},{"code":"360","type":"RC"},{"code":"21550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Soft Tiss Thigh/knee Super","code_information":[{"code":"2200385","type":"CDM"},{"code":"360","type":"RC"},{"code":"27323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Soft Tissue Upper Arm/elbow","code_information":[{"code":"2200387","type":"CDM"},{"code":"360","type":"RC"},{"code":"24066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Vestibule Mouth","code_information":[{"code":"2200389","type":"CDM"},{"code":"360","type":"RC"},{"code":"40808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Biopsy Nasopharynx Visible Lesion Smpl","code_information":[{"code":"2200391","type":"CDM"},{"code":"360","type":"RC"},{"code":"42804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Blepharoplasty Lower Eyelid","code_information":[{"code":"2200396","type":"CDM"},{"code":"360","type":"RC"},{"code":"15820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Bone Aspiration Spine Surgery Only","code_information":[{"code":"2200404","type":"CDM"},{"code":"360","type":"RC"},{"code":"20939","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Bone Graft Any Donor Area Major Or Large","code_information":[{"code":"2200406","type":"CDM"},{"code":"360","type":"RC"},{"code":"20902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Bone For Graft","code_information":[{"code":"2200408","type":"CDM"},{"code":"360","type":"RC"},{"code":"20900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Bone Marrow Harvest Transplant Autolog A","code_information":[{"code":"2200410","type":"CDM"},{"code":"360","type":"RC"},{"code":"38232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Bone Marrow Aspiration Only","code_information":[{"code":"2200412","type":"CDM"},{"code":"360","type":"RC"},{"code":"38220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Breast Diep Or Siea Flap","code_information":[{"code":"2200416","type":"CDM"},{"code":"360","type":"RC"},{"code":"S2068","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Breast Reconstr W/lat Flap","code_information":[{"code":"2200418","type":"CDM"},{"code":"360","type":"RC"},{"code":"19361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Breast Reconstruction","code_information":[{"code":"2200421","type":"CDM"},{"code":"360","type":"RC"},{"code":"19357","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Hip Joint/muscle","code_information":[{"code":"2200427","type":"CDM"},{"code":"360","type":"RC"},{"code":"27036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Capsulec/capsulotomy Ipj Each Jnt Add 1","code_information":[{"code":"2200429","type":"CDM"},{"code":"360","type":"RC"},{"code":"26525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Capsulect/capsulotomy Mp Joint Ea Jnt A","code_information":[{"code":"2200431","type":"CDM"},{"code":"360","type":"RC"},{"code":"26520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair/revise Wrist Joint","code_information":[{"code":"2200433","type":"CDM"},{"code":"360","type":"RC"},{"code":"25320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Cautery Cervix Electro Or Thermal","code_information":[{"code":"2200455","type":"CDM"},{"code":"360","type":"RC"},{"code":"57510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Cerclage Cervix During Preg Abd Add 1 M","code_information":[{"code":"2200459","type":"CDM"},{"code":"360","type":"RC"},{"code":"59325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Cerclage Cervix During Pregnancy Vaginal","code_information":[{"code":"2200461","type":"CDM"},{"code":"360","type":"RC"},{"code":"59320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Lymph Nodes Neck","code_information":[{"code":"2200465","type":"CDM"},{"code":"360","type":"RC"},{"code":"38724","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Circum 28 Days Or Older","code_information":[{"code":"2200478","type":"CDM"},{"code":"360","type":"RC"},{"code":"54161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Circumcision W/regionl Block","code_information":[{"code":"2200480","type":"CDM"},{"code":"360","type":"RC"},{"code":"54150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"2200486","type":"CDM"},{"code":"360","type":"RC"},{"code":"26742","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Closed Tx Calcaneal Fract W/o Manip","code_information":[{"code":"2200489","type":"CDM"},{"code":"360","type":"RC"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Thumb Fracture","code_information":[{"code":"2200491","type":"CDM"},{"code":"360","type":"RC"},{"code":"26645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Finger Tendon","code_information":[{"code":"2200493","type":"CDM"},{"code":"360","type":"RC"},{"code":"26432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Big Toe Fracture","code_information":[{"code":"2200502","type":"CDM"},{"code":"360","type":"RC"},{"code":"28495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Thigh Fracture","code_information":[{"code":"2200504","type":"CDM"},{"code":"360","type":"RC"},{"code":"27240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Metacarpal Fracture","code_information":[{"code":"2200506","type":"CDM"},{"code":"360","type":"RC"},{"code":"26607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Knuckle Dislocation","code_information":[{"code":"2200508","type":"CDM"},{"code":"360","type":"RC"},{"code":"26705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Closed Tx Metatarsal Frct W/o Manip","code_information":[{"code":"2200510","type":"CDM"},{"code":"360","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Finger Fracture Each","code_information":[{"code":"2200518","type":"CDM"},{"code":"360","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Fracture Radius & Ulna","code_information":[{"code":"2200522","type":"CDM"},{"code":"360","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Dislocation/fracture","code_information":[{"code":"2200528","type":"CDM"},{"code":"360","type":"RC"},{"code":"23665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Shoulder Dislocation","code_information":[{"code":"2200530","type":"CDM"},{"code":"360","type":"RC"},{"code":"23655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Closed Tx Talus Fract W/o Manip","code_information":[{"code":"2200532","type":"CDM"},{"code":"360","type":"RC"},{"code":"28430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Closed Tx Trimall Ankle Frct W/manip","code_information":[{"code":"2200534","type":"CDM"},{"code":"360","type":"RC"},{"code":"27818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treatment Of Ankle Fracture","code_information":[{"code":"2200536","type":"CDM"},{"code":"360","type":"RC"},{"code":"27816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Colonoscopy Stoma W/biop Sng/mlt","code_information":[{"code":"2200556","type":"CDM"},{"code":"360","type":"RC"},{"code":"44389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Colostomy With Biopsies","code_information":[{"code":"2200566","type":"CDM"},{"code":"360","type":"RC"},{"code":"44322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Control Of Nosebleed","code_information":[{"code":"2200593","type":"CDM"},{"code":"360","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Control Nose/throat Bleeding","code_information":[{"code":"2200595","type":"CDM"},{"code":"360","type":"RC"},{"code":"42971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Control Throat Bleeding","code_information":[{"code":"2200597","type":"CDM"},{"code":"360","type":"RC"},{"code":"42960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Of Hammertoe","code_information":[{"code":"2200608","type":"CDM"},{"code":"360","type":"RC"},{"code":"28286","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Bladder & Nodes","code_information":[{"code":"2200622","type":"CDM"},{"code":"360","type":"RC"},{"code":"51585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Debridement Bone Incl Epidermis Dermis","code_information":[{"code":"2200738","type":"CDM"},{"code":"360","type":"RC"},{"code":"11047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Debridement Bone 1st 20 Sqcm/<","code_information":[{"code":"2200744","type":"CDM"},{"code":"360","type":"RC"},{"code":"11044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Decompress Forearm 2 Spaces","code_information":[{"code":"2200750","type":"CDM"},{"code":"360","type":"RC"},{"code":"25025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Decompress Forearm 1 Space","code_information":[{"code":"2200754","type":"CDM"},{"code":"360","type":"RC"},{"code":"25020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Delay Flap F/c/c/n/ax/g/h/f","code_information":[{"code":"2200768","type":"CDM"},{"code":"360","type":"RC"},{"code":"15620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Destruct Lesion 15 Or More","code_information":[{"code":"2200772","type":"CDM"},{"code":"360","type":"RC"},{"code":"17111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Destruct B9 Lesion 1-14","code_information":[{"code":"2200774","type":"CDM"},{"code":"360","type":"RC"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Destruction Anal Lesion(s)","code_information":[{"code":"2200788","type":"CDM"},{"code":"360","type":"RC"},{"code":"46924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Destruction Anal Lesion(s)","code_information":[{"code":"2200790","type":"CDM"},{"code":"360","type":"RC"},{"code":"46900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Anal Lesion(s)","code_information":[{"code":"2200792","type":"CDM"},{"code":"360","type":"RC"},{"code":"46922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Laser Surg Penis Lesion(s)","code_information":[{"code":"2200798","type":"CDM"},{"code":"360","type":"RC"},{"code":"54057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Penis Lesion(s)","code_information":[{"code":"2200800","type":"CDM"},{"code":"360","type":"RC"},{"code":"54060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Destroy Vulva Lesion/s Compl","code_information":[{"code":"2200802","type":"CDM"},{"code":"360","type":"RC"},{"code":"56515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"D&c Of Cervical Stump","code_information":[{"code":"2200807","type":"CDM"},{"code":"360","type":"RC"},{"code":"57558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Dilation And Curettage","code_information":[{"code":"2200809","type":"CDM"},{"code":"360","type":"RC"},{"code":"58120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Abscess/hematoma Nasal Septum","code_information":[{"code":"2200829","type":"CDM"},{"code":"360","type":"RC"},{"code":"30020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Of Gum Lesion","code_information":[{"code":"2200835","type":"CDM"},{"code":"360","type":"RC"},{"code":"41800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Abdom Abscess Open","code_information":[{"code":"2200841","type":"CDM"},{"code":"360","type":"RC"},{"code":"49020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Dress/debrid P-thick Burn S","code_information":[{"code":"2200853","type":"CDM"},{"code":"360","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Each Add'l 50cc Injectate","code_information":[{"code":"2200855","type":"CDM"},{"code":"360","type":"RC"},{"code":"15772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Electrical Bone Stimulation","code_information":[{"code":"2200857","type":"CDM"},{"code":"360","type":"RC"},{"code":"20974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Endocervical Curettage","code_information":[{"code":"2200863","type":"CDM"},{"code":"360","type":"RC"},{"code":"57505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Endometr Ablate Thermal","code_information":[{"code":"2200865","type":"CDM"},{"code":"360","type":"RC"},{"code":"58353","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":2196,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Endometrial Sampling Bx W/wo Endocervc","code_information":[{"code":"2200867","type":"CDM"},{"code":"360","type":"RC"},{"code":"58100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Hemorrhoid Clot","code_information":[{"code":"2200893","type":"CDM"},{"code":"360","type":"RC"},{"code":"46320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Epididymectomy Unilateral","code_information":[{"code":"2200895","type":"CDM"},{"code":"360","type":"RC"},{"code":"54860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Aural Polyp","code_information":[{"code":"2200929","type":"CDM"},{"code":"360","type":"RC"},{"code":"69540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Neck Cyst","code_information":[{"code":"2200931","type":"CDM"},{"code":"360","type":"RC"},{"code":"42810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revise Hand/finger Tendon","code_information":[{"code":"2200937","type":"CDM"},{"code":"360","type":"RC"},{"code":"26390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excise Inferior Turbinate","code_information":[{"code":"2200939","type":"CDM"},{"code":"360","type":"RC"},{"code":"30130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Bartholin's Gland Or Cyst","code_information":[{"code":"2200941","type":"CDM"},{"code":"360","type":"RC"},{"code":"56740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Chest Wall Tumor Including Ribs","code_information":[{"code":"2200945","type":"CDM"},{"code":"360","type":"RC"},{"code":"19260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal of one or more breast growth, open procedure","code_information":[{"code":"2200947","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"19120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Extraparenchymal Lesion Testis","code_information":[{"code":"2200949","type":"CDM"},{"code":"360","type":"RC"},{"code":"54512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Wrist Tendon Lesion","code_information":[{"code":"2200951","type":"CDM"},{"code":"360","type":"RC"},{"code":"25111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Hydrocele","code_information":[{"code":"2200955","type":"CDM"},{"code":"360","type":"RC"},{"code":"55500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Hydrocele Bilateral","code_information":[{"code":"2200957","type":"CDM"},{"code":"360","type":"RC"},{"code":"55041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Hydrocele Unilateral","code_information":[{"code":"2200959","type":"CDM"},{"code":"360","type":"RC"},{"code":"55040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Knee Cyst","code_information":[{"code":"2200961","type":"CDM"},{"code":"360","type":"RC"},{"code":"27347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excise/repair Mouth Lesion","code_information":[{"code":"2200963","type":"CDM"},{"code":"360","type":"RC"},{"code":"40812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Mouth Lesion","code_information":[{"code":"2200965","type":"CDM"},{"code":"360","type":"RC"},{"code":"40810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Sperm Cord Lesion","code_information":[{"code":"2200967","type":"CDM"},{"code":"360","type":"RC"},{"code":"55520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Tendon Lesion","code_information":[{"code":"2200969","type":"CDM"},{"code":"360","type":"RC"},{"code":"27630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Tendon Sheath Lesion","code_information":[{"code":"2200971","type":"CDM"},{"code":"360","type":"RC"},{"code":"26160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Tongue Lesion","code_information":[{"code":"2200973","type":"CDM"},{"code":"360","type":"RC"},{"code":"41112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Tongue Lesion","code_information":[{"code":"2200975","type":"CDM"},{"code":"360","type":"RC"},{"code":"41113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Tongue Lesion","code_information":[{"code":"2200977","type":"CDM"},{"code":"360","type":"RC"},{"code":"41114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Of Gum Lesion","code_information":[{"code":"2200979","type":"CDM"},{"code":"360","type":"RC"},{"code":"41826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Foot Lesion","code_information":[{"code":"2200981","type":"CDM"},{"code":"360","type":"RC"},{"code":"28090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Toe Lesions","code_information":[{"code":"2200983","type":"CDM"},{"code":"360","type":"RC"},{"code":"28092","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Lingual Frenum Frenectomy","code_information":[{"code":"2200985","type":"CDM"},{"code":"360","type":"RC"},{"code":"41115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Neuroma Digital Nerve","code_information":[{"code":"2200989","type":"CDM"},{"code":"360","type":"RC"},{"code":"64778","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Digit Nerve Lesion","code_information":[{"code":"2200991","type":"CDM"},{"code":"360","type":"RC"},{"code":"64776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Limb Nerve Lesion","code_information":[{"code":"2200993","type":"CDM"},{"code":"360","type":"RC"},{"code":"64782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Nerve Lesion","code_information":[{"code":"2200995","type":"CDM"},{"code":"360","type":"RC"},{"code":"64784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Pilonidal Cyst Compl","code_information":[{"code":"2201003","type":"CDM"},{"code":"360","type":"RC"},{"code":"11772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Pilonidal Cyst Exten","code_information":[{"code":"2201005","type":"CDM"},{"code":"360","type":"RC"},{"code":"11771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Pilonidal Cyst Or Sinus Simple","code_information":[{"code":"2201007","type":"CDM"},{"code":"360","type":"RC"},{"code":"11770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Rect Tum Transanal Full","code_information":[{"code":"2201009","type":"CDM"},{"code":"360","type":"RC"},{"code":"45172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Rect Tum Transanal Part","code_information":[{"code":"2201011","type":"CDM"},{"code":"360","type":"RC"},{"code":"45171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Sweat Gland Lesion","code_information":[{"code":"2201016","type":"CDM"},{"code":"360","type":"RC"},{"code":"11450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Epididymis Lesion","code_information":[{"code":"2201022","type":"CDM"},{"code":"360","type":"RC"},{"code":"54840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excise Submaxillary Gland","code_information":[{"code":"2201024","type":"CDM"},{"code":"360","type":"RC"},{"code":"42440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Thyroglossal Duct Cyst Or Sinus","code_information":[{"code":"2201029","type":"CDM"},{"code":"360","type":"RC"},{"code":"60280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Vaginal Cyst Or Tumor","code_information":[{"code":"2201033","type":"CDM"},{"code":"360","type":"RC"},{"code":"57135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revise Spermatic Cord Veins","code_information":[{"code":"2201035","type":"CDM"},{"code":"360","type":"RC"},{"code":"55530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revise Hernia & Sperm Veins","code_information":[{"code":"2201037","type":"CDM"},{"code":"360","type":"RC"},{"code":"55540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Hand Bone Lesion","code_information":[{"code":"2201041","type":"CDM"},{"code":"360","type":"RC"},{"code":"26200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Finger Lesion","code_information":[{"code":"2201043","type":"CDM"},{"code":"360","type":"RC"},{"code":"26210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove/graft Foot Lesion","code_information":[{"code":"2201049","type":"CDM"},{"code":"360","type":"RC"},{"code":"28103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove/graft Foot Lesion","code_information":[{"code":"2201053","type":"CDM"},{"code":"360","type":"RC"},{"code":"28107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excise Pharynx Lesion 1st","code_information":[{"code":"2201061","type":"CDM"},{"code":"360","type":"RC"},{"code":"42808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Abd Tum 5 Cm Or Less","code_information":[{"code":"2201063","type":"CDM"},{"code":"360","type":"RC"},{"code":"49203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Eye Lesion","code_information":[{"code":"2201067","type":"CDM"},{"code":"360","type":"RC"},{"code":"65426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Hand Les Sc 1.5 Cm/>","code_information":[{"code":"2201071","type":"CDM"},{"code":"360","type":"RC"},{"code":"26111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Abd Les Sc 3 Cm/>","code_information":[{"code":"2201073","type":"CDM"},{"code":"360","type":"RC"},{"code":"22903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Abd Les Sc < 3 Cm","code_information":[{"code":"2201075","type":"CDM"},{"code":"360","type":"RC"},{"code":"22902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Face Tum Deep < 2 Cm","code_information":[{"code":"2201079","type":"CDM"},{"code":"360","type":"RC"},{"code":"21013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Foot/toe Tum Sc 1.5 Cm/>","code_information":[{"code":"2201081","type":"CDM"},{"code":"360","type":"RC"},{"code":"28039","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Foot/toe Tum Dep 1.5cm/>","code_information":[{"code":"2201083","type":"CDM"},{"code":"360","type":"RC"},{"code":"28041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Forearm Les Sc 3 Cm/>","code_information":[{"code":"2201085","type":"CDM"},{"code":"360","type":"RC"},{"code":"25071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Hip Pelvis Les Sc 3 Cm/>","code_information":[{"code":"2201089","type":"CDM"},{"code":"360","type":"RC"},{"code":"27043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Shoulder Tum Deep 5 Cm/>","code_information":[{"code":"2201091","type":"CDM"},{"code":"360","type":"RC"},{"code":"23073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Arm/elbow Les Sc 3 Cm/>","code_information":[{"code":"2201095","type":"CDM"},{"code":"360","type":"RC"},{"code":"24071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ex Arm/elbow Tum Deep 5 Cm/>","code_information":[{"code":"2201097","type":"CDM"},{"code":"360","type":"RC"},{"code":"24073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Neck Les Sc < 3 Cm","code_information":[{"code":"2201101","type":"CDM"},{"code":"360","type":"RC"},{"code":"21555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc H-f-nk-sp B9+marg 1.1-3","code_information":[{"code":"2201109","type":"CDM"},{"code":"360","type":"RC"},{"code":"11422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Excessive Skin & Subq Tissue","code_information":[{"code":"2201129","type":"CDM"},{"code":"360","type":"RC"},{"code":"15847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excise Excessive Skin Arm","code_information":[{"code":"2201133","type":"CDM"},{"code":"360","type":"RC"},{"code":"15836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excise Excessive Skin Hip","code_information":[{"code":"2201135","type":"CDM"},{"code":"360","type":"RC"},{"code":"15834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excise Excessive Skin Thigh","code_information":[{"code":"2201141","type":"CDM"},{"code":"360","type":"RC"},{"code":"15832","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Foot Lesion","code_information":[{"code":"2201143","type":"CDM"},{"code":"360","type":"RC"},{"code":"28080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Lesion Mouth Roof","code_information":[{"code":"2201145","type":"CDM"},{"code":"360","type":"RC"},{"code":"42107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Lesion Palate Uvula W/o Closure","code_information":[{"code":"2201147","type":"CDM"},{"code":"360","type":"RC"},{"code":"42104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Wrist Tendon Lesion","code_information":[{"code":"2201149","type":"CDM"},{"code":"360","type":"RC"},{"code":"25110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Tr-ext Mal+marg >4 Cm","code_information":[{"code":"2201168","type":"CDM"},{"code":"360","type":"RC"},{"code":"11606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Nasal Polyps Simple","code_information":[{"code":"2201172","type":"CDM"},{"code":"360","type":"RC"},{"code":"30110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Shoulder Les Sc < 3 Cm","code_information":[{"code":"2201190","type":"CDM"},{"code":"360","type":"RC"},{"code":"23075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Hand Tum Deep < 1.5 Cm","code_information":[{"code":"2201192","type":"CDM"},{"code":"360","type":"RC"},{"code":"26116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Hand Les Sc < 1.5 Cm","code_information":[{"code":"2201194","type":"CDM"},{"code":"360","type":"RC"},{"code":"26115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Foot/toe Tum Deep <1.5cm","code_information":[{"code":"2201196","type":"CDM"},{"code":"360","type":"RC"},{"code":"28045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Tumor Foot Subcutaneous Tissue","code_information":[{"code":"2201198","type":"CDM"},{"code":"360","type":"RC"},{"code":"28043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Leg/ankle Tum < 3 Cm","code_information":[{"code":"2201200","type":"CDM"},{"code":"360","type":"RC"},{"code":"27618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Excision Tumor Soft Tissue Back Or Flank","code_information":[{"code":"2201203","type":"CDM"},{"code":"360","type":"RC"},{"code":"21930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Back Les Sc 3 Cm/>","code_information":[{"code":"2201205","type":"CDM"},{"code":"360","type":"RC"},{"code":"21931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Back Tum Deep 5 Cm/>","code_information":[{"code":"2201207","type":"CDM"},{"code":"360","type":"RC"},{"code":"21933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Back Tum Deep < 5 Cm","code_information":[{"code":"2201209","type":"CDM"},{"code":"360","type":"RC"},{"code":"21932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Face Tum Deep 2 Cm/>","code_information":[{"code":"2201211","type":"CDM"},{"code":"360","type":"RC"},{"code":"21014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Forearm Tum Deep < 3 Cm","code_information":[{"code":"2201217","type":"CDM"},{"code":"360","type":"RC"},{"code":"25076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Forearm Les Sc < 3 Cm","code_information":[{"code":"2201219","type":"CDM"},{"code":"360","type":"RC"},{"code":"25075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Neck Les Sc 3 Cm/>","code_information":[{"code":"2201221","type":"CDM"},{"code":"360","type":"RC"},{"code":"21552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Thigh/knee Les Sc 3 Cm/>","code_information":[{"code":"2201225","type":"CDM"},{"code":"360","type":"RC"},{"code":"27337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ex Arm/elbow Tum Deep < 5 Cm","code_information":[{"code":"2201227","type":"CDM"},{"code":"360","type":"RC"},{"code":"24076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Arm/elbow Les Sc < 3 Cm","code_information":[{"code":"2201229","type":"CDM"},{"code":"360","type":"RC"},{"code":"24075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Hand Tum Deep 1.5 Cm/>","code_information":[{"code":"2201231","type":"CDM"},{"code":"360","type":"RC"},{"code":"26113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Thigh/knee Tum Deep <5cm","code_information":[{"code":"2201233","type":"CDM"},{"code":"360","type":"RC"},{"code":"27328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exc Thigh/knee Les Sc < 3 Cm","code_information":[{"code":"2201235","type":"CDM"},{"code":"360","type":"RC"},{"code":"27327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exploration For Testis","code_information":[{"code":"2201239","type":"CDM"},{"code":"360","type":"RC"},{"code":"54550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Exploration/repair Of Rectum","code_information":[{"code":"2201249","type":"CDM"},{"code":"360","type":"RC"},{"code":"45562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Release Palm Contracture","code_information":[{"code":"2201261","type":"CDM"},{"code":"360","type":"RC"},{"code":"26123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Fasciectomy Partial Palmar W/release","code_information":[{"code":"2201263","type":"CDM"},{"code":"360","type":"RC"},{"code":"26125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Partial Removal Foot Fascia","code_information":[{"code":"2201265","type":"CDM"},{"code":"360","type":"RC"},{"code":"28060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Foot Fascia","code_information":[{"code":"2201267","type":"CDM"},{"code":"360","type":"RC"},{"code":"28062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Fasciotomy Foot And/or Toe","code_information":[{"code":"2201269","type":"CDM"},{"code":"360","type":"RC"},{"code":"28008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Fasciotomy Hip Or Thigh Any Type","code_information":[{"code":"2201271","type":"CDM"},{"code":"360","type":"RC"},{"code":"27025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Release Palm Contracture","code_information":[{"code":"2201273","type":"CDM"},{"code":"360","type":"RC"},{"code":"26045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Release Palm Contracture","code_information":[{"code":"2201275","type":"CDM"},{"code":"360","type":"RC"},{"code":"26040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Fissurectomy W/wo Sphincterotomy","code_information":[{"code":"2201281","type":"CDM"},{"code":"360","type":"RC"},{"code":"46200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Suspension Of Testis","code_information":[{"code":"2201283","type":"CDM"},{"code":"360","type":"RC"},{"code":"54620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ther Fx Nasal Inf Turbinate","code_information":[{"code":"2201288","type":"CDM"},{"code":"360","type":"RC"},{"code":"30930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Free Skin Flap Microvasc","code_information":[{"code":"2201290","type":"CDM"},{"code":"360","type":"RC"},{"code":"15757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Reconstruction Tongue Fold","code_information":[{"code":"2201292","type":"CDM"},{"code":"360","type":"RC"},{"code":"41520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Frenulotomy Penis","code_information":[{"code":"2201294","type":"CDM"},{"code":"360","type":"RC"},{"code":"54164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Skin Full Grft Face/genit/hf","code_information":[{"code":"2201296","type":"CDM"},{"code":"360","type":"RC"},{"code":"15240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Skin Full Graft Een & Lips","code_information":[{"code":"2201298","type":"CDM"},{"code":"360","type":"RC"},{"code":"15260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Reconstruction Of Chin","code_information":[{"code":"2201312","type":"CDM"},{"code":"360","type":"RC"},{"code":"21120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":2196,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ear Cartilage Graft","code_information":[{"code":"2201314","type":"CDM"},{"code":"360","type":"RC"},{"code":"21235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":2196,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Grfg Autol Fat Lipo 50 Cc/<","code_information":[{"code":"2201316","type":"CDM"},{"code":"360","type":"RC"},{"code":"15771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Grfg Autol Fat Lipo 25 Cc/<","code_information":[{"code":"2201318","type":"CDM"},{"code":"360","type":"RC"},{"code":"15773","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Grfg Autol Soft Tiss Dir Exc","code_information":[{"code":"2201320","type":"CDM"},{"code":"360","type":"RC"},{"code":"15769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Int Hrhc Tranal Dartlzj 2+","code_information":[{"code":"2201330","type":"CDM"},{"code":"360","type":"RC"},{"code":"46948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ligation Of Hemorrhoid(s)","code_information":[{"code":"2201332","type":"CDM"},{"code":"360","type":"RC"},{"code":"46221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove In/ex Hem Groups 2+","code_information":[{"code":"2201335","type":"CDM"},{"code":"360","type":"RC"},{"code":"46260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove In/ex Hem Grps & Fiss","code_information":[{"code":"2201337","type":"CDM"},{"code":"360","type":"RC"},{"code":"46261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove In/ex Hem Grps W/fist","code_information":[{"code":"2201339","type":"CDM"},{"code":"360","type":"RC"},{"code":"46262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Int/ext Hem 1 Group","code_information":[{"code":"2201341","type":"CDM"},{"code":"360","type":"RC"},{"code":"46255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove In/ex Hem Grp & Fiss","code_information":[{"code":"2201343","type":"CDM"},{"code":"360","type":"RC"},{"code":"46257","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove In/ex Hem Grp W/fistu","code_information":[{"code":"2201345","type":"CDM"},{"code":"360","type":"RC"},{"code":"46258","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Extensive Removal Of Liver","code_information":[{"code":"2201347","type":"CDM"},{"code":"360","type":"RC"},{"code":"47122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Hysteroscopy Dx Sep Proc","code_information":[{"code":"2201349","type":"CDM"},{"code":"360","type":"RC"},{"code":"58555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Hysteroscopy Resect Septum","code_information":[{"code":"2201353","type":"CDM"},{"code":"360","type":"RC"},{"code":"58560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Hysteroscopy Ablation","code_information":[{"code":"2201355","type":"CDM"},{"code":"360","type":"RC"},{"code":"58563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Hysteroscopy Lysis","code_information":[{"code":"2201357","type":"CDM"},{"code":"360","type":"RC"},{"code":"58559","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Hysteroscopy Remove Fb","code_information":[{"code":"2201359","type":"CDM"},{"code":"360","type":"RC"},{"code":"58562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Hysteroscopy With Removal Leiomyomata","code_information":[{"code":"2201361","type":"CDM"},{"code":"360","type":"RC"},{"code":"58561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Hysteroscopy Biopsy","code_information":[{"code":"2201363","type":"CDM"},{"code":"360","type":"RC"},{"code":"58558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Implantation Biologic Implant","code_information":[{"code":"2201367","type":"CDM"},{"code":"360","type":"RC"},{"code":"15777","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Of Tonsil Abscess","code_information":[{"code":"2201375","type":"CDM"},{"code":"360","type":"RC"},{"code":"42700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Of Throat Abscess","code_information":[{"code":"2201377","type":"CDM"},{"code":"360","type":"RC"},{"code":"42720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treatment Of Foot Infection","code_information":[{"code":"2201381","type":"CDM"},{"code":"360","type":"RC"},{"code":"28002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Of Gland Abscess","code_information":[{"code":"2201386","type":"CDM"},{"code":"360","type":"RC"},{"code":"56420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Of Scrotum","code_information":[{"code":"2201388","type":"CDM"},{"code":"360","type":"RC"},{"code":"54700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Incision Of Rectal Abscess","code_information":[{"code":"2201392","type":"CDM"},{"code":"360","type":"RC"},{"code":"46045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Incision Of Rectal Abscess","code_information":[{"code":"2201394","type":"CDM"},{"code":"360","type":"RC"},{"code":"46040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"I & D Of Vulva/perineum","code_information":[{"code":"2201401","type":"CDM"},{"code":"360","type":"RC"},{"code":"56405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Complex Drainage Wound","code_information":[{"code":"2201403","type":"CDM"},{"code":"360","type":"RC"},{"code":"10180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drain Thigh/knee Lesion","code_information":[{"code":"2201405","type":"CDM"},{"code":"360","type":"RC"},{"code":"27301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Of Forearm Lesion","code_information":[{"code":"2201407","type":"CDM"},{"code":"360","type":"RC"},{"code":"25028","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drain Lower Leg Lesion","code_information":[{"code":"2201409","type":"CDM"},{"code":"360","type":"RC"},{"code":"27603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"I&d P-spine C/t/cerv-thor","code_information":[{"code":"2201411","type":"CDM"},{"code":"360","type":"RC"},{"code":"22010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Of Pelvis Lesion","code_information":[{"code":"2201415","type":"CDM"},{"code":"360","type":"RC"},{"code":"26990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Incision Of Anal Abscess","code_information":[{"code":"2201417","type":"CDM"},{"code":"360","type":"RC"},{"code":"46050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drain Shoulder Lesion","code_information":[{"code":"2201419","type":"CDM"},{"code":"360","type":"RC"},{"code":"23030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drainage Of Arm Lesion","code_information":[{"code":"2201421","type":"CDM"},{"code":"360","type":"RC"},{"code":"23930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Implant Neuroelectrodes","code_information":[{"code":"2201427","type":"CDM"},{"code":"360","type":"RC"},{"code":"64581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Foot Bone Lesion","code_information":[{"code":"2201429","type":"CDM"},{"code":"360","type":"RC"},{"code":"28005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Incision Of Tendon Sheath","code_information":[{"code":"2201431","type":"CDM"},{"code":"360","type":"RC"},{"code":"25000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Induced Abortion By Dilation&evacuat","code_information":[{"code":"2201435","type":"CDM"},{"code":"360","type":"RC"},{"code":"59841","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Inj Proc -Identification Sentinel Node","code_information":[{"code":"2201459","type":"CDM"},{"code":"360","type":"RC"},{"code":"38792","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Insertion Intrauterine Device Iud","code_information":[{"code":"2201549","type":"CDM"},{"code":"360","type":"RC"},{"code":"58300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Insert Tissue Expander(s)","code_information":[{"code":"2201567","type":"CDM"},{"code":"360","type":"RC"},{"code":"11960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Insert Drug Implant Device","code_information":[{"code":"2201580","type":"CDM"},{"code":"360","type":"RC"},{"code":"11981","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treatment Of Penis Lesion","code_information":[{"code":"2201589","type":"CDM"},{"code":"360","type":"RC"},{"code":"54220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Laparoscopy Surg Colpopexy","code_information":[{"code":"2201641","type":"CDM"},{"code":"360","type":"RC"},{"code":"57425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Laparoscopy Adrenalectomy","code_information":[{"code":"2201683","type":"CDM"},{"code":"360","type":"RC"},{"code":"60650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Laparo Ligate Spermatic Vein","code_information":[{"code":"2201685","type":"CDM"},{"code":"360","type":"RC"},{"code":"55550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1868,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Laparo Partial Colectomy","code_information":[{"code":"2201703","type":"CDM"},{"code":"360","type":"RC"},{"code":"44204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Lap Insert Tunnel Ip Cath","code_information":[{"code":"2201721","type":"CDM"},{"code":"360","type":"RC"},{"code":"49324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Diagnostic Laryngoscopy","code_information":[{"code":"2201741","type":"CDM"},{"code":"360","type":"RC"},{"code":"31575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Intmd Rpr Face/mm 20.1-30.0","code_information":[{"code":"2201760","type":"CDM"},{"code":"360","type":"RC"},{"code":"12056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Int Hrhc Lig 2+hroid W/o Img","code_information":[{"code":"2201778","type":"CDM"},{"code":"360","type":"RC"},{"code":"46946","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Int Hrhc Lig 1 Hroid W/o Img","code_information":[{"code":"2201780","type":"CDM"},{"code":"360","type":"RC"},{"code":"46945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Limited Pharyngectomy","code_information":[{"code":"2201786","type":"CDM"},{"code":"360","type":"RC"},{"code":"42890","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":2196,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Lysis Intranasal Synechia","code_information":[{"code":"2201795","type":"CDM"},{"code":"360","type":"RC"},{"code":"30560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Lysis Penil Circumic Lesion","code_information":[{"code":"2201799","type":"CDM"},{"code":"360","type":"RC"},{"code":"54162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Malar Augmentation Prosthetic Material","code_information":[{"code":"2201801","type":"CDM"},{"code":"360","type":"RC"},{"code":"21270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Enlarge Breast With Implant","code_information":[{"code":"2201803","type":"CDM"},{"code":"360","type":"RC"},{"code":"19325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":2948,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2948},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Fixation Of Knee Joint","code_information":[{"code":"2201807","type":"CDM"},{"code":"360","type":"RC"},{"code":"27570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Fixation Of Shoulder","code_information":[{"code":"2201809","type":"CDM"},{"code":"360","type":"RC"},{"code":"23700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Manipulate Finger W/anesth","code_information":[{"code":"2201811","type":"CDM"},{"code":"360","type":"RC"},{"code":"26340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Drug Delivery Devices Intraarticular","code_information":[{"code":"2201814","type":"CDM"},{"code":"360","type":"RC"},{"code":"20704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Marsupialization Bartholin's Gland Cyst","code_information":[{"code":"2201816","type":"CDM"},{"code":"360","type":"RC"},{"code":"56440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Mastectomy For Gynecomastia1236","code_information":[{"code":"2201818","type":"CDM"},{"code":"360","type":"RC"},{"code":"19300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Mast Mod Rad","code_information":[{"code":"2201820","type":"CDM"},{"code":"360","type":"RC"},{"code":"19307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Partial Mastectomy","code_information":[{"code":"2201822","type":"CDM"},{"code":"360","type":"RC"},{"code":"19301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Mast Radical","code_information":[{"code":"2201826","type":"CDM"},{"code":"360","type":"RC"},{"code":"19305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Mastectomy Simple Complete89717","code_information":[{"code":"2201828","type":"CDM"},{"code":"360","type":"RC"},{"code":"19303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Mastopexy","code_information":[{"code":"2201830","type":"CDM"},{"code":"360","type":"RC"},{"code":"19316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Incision Of Urethra","code_information":[{"code":"2201835","type":"CDM"},{"code":"360","type":"RC"},{"code":"53020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Metatarsectomy","code_information":[{"code":"2201837","type":"CDM"},{"code":"360","type":"RC"},{"code":"28140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Muscle-skin Graft Trunk","code_information":[{"code":"2201845","type":"CDM"},{"code":"360","type":"RC"},{"code":"15734","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Myomectomy Abdom Method","code_information":[{"code":"2201848","type":"CDM"},{"code":"360","type":"RC"},{"code":"58140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":2196,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Myomectomy Vag Method","code_information":[{"code":"2201850","type":"CDM"},{"code":"360","type":"RC"},{"code":"58145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Nasal/sinus Endoscopy Surg","code_information":[{"code":"2201890","type":"CDM"},{"code":"360","type":"RC"},{"code":"31238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Ovary(s)","code_information":[{"code":"2201940","type":"CDM"},{"code":"360","type":"RC"},{"code":"58940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Open Periprosthetic Capsulotomy Breast","code_information":[{"code":"2201942","type":"CDM"},{"code":"360","type":"RC"},{"code":"19370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Elbow Dislocation","code_information":[{"code":"2201948","type":"CDM"},{"code":"360","type":"RC"},{"code":"24615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Wrist Bone Fracture","code_information":[{"code":"2201956","type":"CDM"},{"code":"360","type":"RC"},{"code":"25628","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Opn Tx Orbit Fx W/o Implant","code_information":[{"code":"2201984","type":"CDM"},{"code":"360","type":"RC"},{"code":"21406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Humerus Fracture","code_information":[{"code":"2201998","type":"CDM"},{"code":"360","type":"RC"},{"code":"24579","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Fracture Radius/ulna","code_information":[{"code":"2202034","type":"CDM"},{"code":"360","type":"RC"},{"code":"25575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Fracture Radius & Ulna","code_information":[{"code":"2202036","type":"CDM"},{"code":"360","type":"RC"},{"code":"25574","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treatment Of Ankle Fracture","code_information":[{"code":"2202062","type":"CDM"},{"code":"360","type":"RC"},{"code":"27822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Open Inguinofemoral Nodes","code_information":[{"code":"2202070","type":"CDM"},{"code":"360","type":"RC"},{"code":"38531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Testis","code_information":[{"code":"2202076","type":"CDM"},{"code":"360","type":"RC"},{"code":"54530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Testis","code_information":[{"code":"2202078","type":"CDM"},{"code":"360","type":"RC"},{"code":"54520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revision Of Toe","code_information":[{"code":"2202109","type":"CDM"},{"code":"360","type":"RC"},{"code":"28312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Osteotomy Ulna","code_information":[{"code":"2202129","type":"CDM"},{"code":"360","type":"RC"},{"code":"25360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revise External Ear","code_information":[{"code":"2202131","type":"CDM"},{"code":"360","type":"RC"},{"code":"69300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Partial Removal Of Tibia","code_information":[{"code":"2202143","type":"CDM"},{"code":"360","type":"RC"},{"code":"27640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Partial Removal Finger Bone","code_information":[{"code":"2202151","type":"CDM"},{"code":"360","type":"RC"},{"code":"26236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Fx Distal Radial","code_information":[{"code":"2202181","type":"CDM"},{"code":"360","type":"RC"},{"code":"25606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Pin Radioulnar Dislocation","code_information":[{"code":"2202183","type":"CDM"},{"code":"360","type":"RC"},{"code":"25671","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Pin Finger Dislocation","code_information":[{"code":"2202189","type":"CDM"},{"code":"360","type":"RC"},{"code":"26776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Toe Dislocation","code_information":[{"code":"2202191","type":"CDM"},{"code":"360","type":"RC"},{"code":"28666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Periprosthetic Capsulectomy Breast","code_information":[{"code":"2202221","type":"CDM"},{"code":"360","type":"RC"},{"code":"19371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Peritoneal Lavage","code_information":[{"code":"2202223","type":"CDM"},{"code":"360","type":"RC"},{"code":"49084","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Cover Eye W/membrane Suture","code_information":[{"code":"2202227","type":"CDM"},{"code":"360","type":"RC"},{"code":"65779","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Place Device/marker Non Pro","code_information":[{"code":"2202231","type":"CDM"},{"code":"360","type":"RC"},{"code":"C9728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Placement Seton","code_information":[{"code":"2202235","type":"CDM"},{"code":"360","type":"RC"},{"code":"46020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Open Bowel To Skin","code_information":[{"code":"2202237","type":"CDM"},{"code":"360","type":"RC"},{"code":"44300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Penis Plastic Surgery","code_information":[{"code":"2202239","type":"CDM"},{"code":"360","type":"RC"},{"code":"54360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Rectum & Vagina","code_information":[{"code":"2202241","type":"CDM"},{"code":"360","type":"RC"},{"code":"57250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Correct Rectal Prolapse","code_information":[{"code":"2202249","type":"CDM"},{"code":"360","type":"RC"},{"code":"45541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Of Rectum","code_information":[{"code":"2202251","type":"CDM"},{"code":"360","type":"RC"},{"code":"45505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Proctosigmoidoscopy Dx","code_information":[{"code":"2202253","type":"CDM"},{"code":"360","type":"RC"},{"code":"45300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Radial Styloidectomy Separate Procedure","code_information":[{"code":"2202267","type":"CDM"},{"code":"360","type":"RC"},{"code":"25230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Radical Resect Abd Tumor 5cm/>","code_information":[{"code":"2202273","type":"CDM"},{"code":"360","type":"RC"},{"code":"22905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Radical Resect Abd Tumor<5cm","code_information":[{"code":"2202275","type":"CDM"},{"code":"360","type":"RC"},{"code":"22904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Back Tum 5 Cm/>","code_information":[{"code":"2202277","type":"CDM"},{"code":"360","type":"RC"},{"code":"21936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Foot/toe Tumor 3 Cm/>","code_information":[{"code":"2202279","type":"CDM"},{"code":"360","type":"RC"},{"code":"28047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Forarm/wrist Tum 3cm>","code_information":[{"code":"2202281","type":"CDM"},{"code":"360","type":"RC"},{"code":"25078","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Neck Tumor 5 Cm/>","code_information":[{"code":"2202283","type":"CDM"},{"code":"360","type":"RC"},{"code":"21558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Arm/elbow Tum 5 Cm/>","code_information":[{"code":"2202285","type":"CDM"},{"code":"360","type":"RC"},{"code":"24079","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Back Tum < 5 Cm","code_information":[{"code":"2202287","type":"CDM"},{"code":"360","type":"RC"},{"code":"21935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Face/scalp Tum < 2 Cm","code_information":[{"code":"2202289","type":"CDM"},{"code":"360","type":"RC"},{"code":"21015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Rad Resect Hand Tumor < 3 Cm","code_information":[{"code":"2202292","type":"CDM"},{"code":"360","type":"RC"},{"code":"26117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Neck Thorax Tumor<5cm","code_information":[{"code":"2202294","type":"CDM"},{"code":"360","type":"RC"},{"code":"21557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Resect Thigh/knee Tum < 5 Cm","code_information":[{"code":"2202296","type":"CDM"},{"code":"360","type":"RC"},{"code":"27329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Reconstruct Ulna/radioulnar","code_information":[{"code":"2202300","type":"CDM"},{"code":"360","type":"RC"},{"code":"25337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Deformity Of Toe","code_information":[{"code":"2202310","type":"CDM"},{"code":"360","type":"RC"},{"code":"28313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Hand Joint With Graft","code_information":[{"code":"2202312","type":"CDM"},{"code":"360","type":"RC"},{"code":"26542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Hand Joint With Graft","code_information":[{"code":"2202314","type":"CDM"},{"code":"360","type":"RC"},{"code":"26541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":2196,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Reduction Mammaplasty","code_information":[{"code":"2202316","type":"CDM"},{"code":"360","type":"RC"},{"code":"19318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Release Thumb Contracture","code_information":[{"code":"2202324","type":"CDM"},{"code":"360","type":"RC"},{"code":"26508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Decompression Of Tibia Nerve","code_information":[{"code":"2202326","type":"CDM"},{"code":"360","type":"RC"},{"code":"28035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Contour Of Face Bone Lesion","code_information":[{"code":"2202334","type":"CDM"},{"code":"360","type":"RC"},{"code":"21029","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Ankle Implant","code_information":[{"code":"2202348","type":"CDM"},{"code":"360","type":"RC"},{"code":"27704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Foreign Body Foot Subcutaneous","code_information":[{"code":"2202361","type":"CDM"},{"code":"360","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Arm Foreign Body","code_information":[{"code":"2202363","type":"CDM"},{"code":"360","type":"RC"},{"code":"24200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Implant From Finger Or Hand","code_information":[{"code":"2202367","type":"CDM"},{"code":"360","type":"RC"},{"code":"26320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Support Implant","code_information":[{"code":"2202369","type":"CDM"},{"code":"360","type":"RC"},{"code":"20680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Intact Mammary Implant","code_information":[{"code":"2202373","type":"CDM"},{"code":"360","type":"RC"},{"code":"19328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Knee Prosthesis","code_information":[{"code":"2202387","type":"CDM"},{"code":"360","type":"RC"},{"code":"27488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Remove Drug Implant Device","code_information":[{"code":"2202414","type":"CDM"},{"code":"360","type":"RC"},{"code":"11982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Reconstruct Finger Joint","code_information":[{"code":"2202418","type":"CDM"},{"code":"360","type":"RC"},{"code":"26548","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Blood Vessel Lesion","code_information":[{"code":"2202420","type":"CDM"},{"code":"360","type":"RC"},{"code":"35206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Rpr Rem Hernia Init Reduce","code_information":[{"code":"2202424","type":"CDM"},{"code":"360","type":"RC"},{"code":"49550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repr Elbw Med Ligmnt W/tissu","code_information":[{"code":"2202440","type":"CDM"},{"code":"360","type":"RC"},{"code":"24345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Eyelid Defect","code_information":[{"code":"2202446","type":"CDM"},{"code":"360","type":"RC"},{"code":"67904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Eyelid Defect","code_information":[{"code":"2202448","type":"CDM"},{"code":"360","type":"RC"},{"code":"67908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Brow Defect","code_information":[{"code":"2202450","type":"CDM"},{"code":"360","type":"RC"},{"code":"67900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Spinal Fluid Leakage","code_information":[{"code":"2202458","type":"CDM"},{"code":"360","type":"RC"},{"code":"63707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Entropion Suture","code_information":[{"code":"2202462","type":"CDM"},{"code":"360","type":"RC"},{"code":"67921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Fibula Nonunion","code_information":[{"code":"2202470","type":"CDM"},{"code":"360","type":"RC"},{"code":"27726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Nail Bed","code_information":[{"code":"2202474","type":"CDM"},{"code":"360","type":"RC"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Of Lower Leg","code_information":[{"code":"2202480","type":"CDM"},{"code":"360","type":"RC"},{"code":"27725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Rectocele Separate Procedure","code_information":[{"code":"2202482","type":"CDM"},{"code":"360","type":"RC"},{"code":"45560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Finger/hand Tendon","code_information":[{"code":"2202490","type":"CDM"},{"code":"360","type":"RC"},{"code":"26370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Finger/hand Tendon","code_information":[{"code":"2202496","type":"CDM"},{"code":"360","type":"RC"},{"code":"26350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair/graft Hand Tendon","code_information":[{"code":"2202498","type":"CDM"},{"code":"360","type":"RC"},{"code":"26352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Cmplx Rpr F/c/c/m/n/ax/g/h/f","code_information":[{"code":"2202520","type":"CDM"},{"code":"360","type":"RC"},{"code":"13131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Cmplx Rpr F/c/c/m/n/ax/g/h/f","code_information":[{"code":"2202522","type":"CDM"},{"code":"360","type":"RC"},{"code":"13132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Finger Tendon","code_information":[{"code":"2202536","type":"CDM"},{"code":"360","type":"RC"},{"code":"26418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Laceration Palate Up To 2 Cm","code_information":[{"code":"2202548","type":"CDM"},{"code":"360","type":"RC"},{"code":"42180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Replace G/c Tube Perc","code_information":[{"code":"2202583","type":"CDM"},{"code":"360","type":"RC"},{"code":"49450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Replace Tissue Expander","code_information":[{"code":"2202585","type":"CDM"},{"code":"360","type":"RC"},{"code":"11970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revision Reconstructed Breast","code_information":[{"code":"2202605","type":"CDM"},{"code":"360","type":"RC"},{"code":"19380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revise/remove Neuroelectrode","code_information":[{"code":"2202621","type":"CDM"},{"code":"360","type":"RC"},{"code":"64585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revise/rmv Pn/gastr Stimul","code_information":[{"code":"2202623","type":"CDM"},{"code":"360","type":"RC"},{"code":"64595","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Reconstruction Of Nose","code_information":[{"code":"2202631","type":"CDM"},{"code":"360","type":"RC"},{"code":"30400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1508,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Rhytidectomy Cheek Chin And Neck","code_information":[{"code":"2202637","type":"CDM"},{"code":"360","type":"RC"},{"code":"15828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Neck Wrinkles","code_information":[{"code":"2202639","type":"CDM"},{"code":"360","type":"RC"},{"code":"15825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Scrotal Exploration","code_information":[{"code":"2202643","type":"CDM"},{"code":"360","type":"RC"},{"code":"55110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Shave Skin Lesion 0.5 Cm/<","code_information":[{"code":"2202651","type":"CDM"},{"code":"360","type":"RC"},{"code":"11310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Sigmoidoscopy & Polypectomy","code_information":[{"code":"2202660","type":"CDM"},{"code":"360","type":"RC"},{"code":"45333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Slitting Of Prepuce","code_information":[{"code":"2202671","type":"CDM"},{"code":"360","type":"RC"},{"code":"54001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Spinal Puncture Drainage Of Csf","code_information":[{"code":"2202675","type":"CDM"},{"code":"360","type":"RC"},{"code":"62272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Wound Prep F/n/hf/g","code_information":[{"code":"2202697","type":"CDM"},{"code":"360","type":"RC"},{"code":"15004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Surgical Prep Burn Recipient Site","code_information":[{"code":"2202699","type":"CDM"},{"code":"360","type":"RC"},{"code":"15003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Wound Prep Trk/arm/leg","code_information":[{"code":"2202701","type":"CDM"},{"code":"360","type":"RC"},{"code":"15002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Suture Digital Nerve Hand Or Foot","code_information":[{"code":"2202713","type":"CDM"},{"code":"360","type":"RC"},{"code":"64832","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Suture Large Intestine","code_information":[{"code":"2202719","type":"CDM"},{"code":"360","type":"RC"},{"code":"44604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Repair Of Hand Or Foot Nerve","code_information":[{"code":"2202721","type":"CDM"},{"code":"360","type":"RC"},{"code":"64834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Suture One Nerve Ulnar Motor","code_information":[{"code":"2202723","type":"CDM"},{"code":"360","type":"RC"},{"code":"64836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Fusion Of Toes","code_information":[{"code":"2202727","type":"CDM"},{"code":"360","type":"RC"},{"code":"28280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Synovectomy Tendon Sheath Foot Extensor","code_information":[{"code":"2202731","type":"CDM"},{"code":"360","type":"RC"},{"code":"28088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Release Of Lower Leg Tendons","code_information":[{"code":"2202747","type":"CDM"},{"code":"360","type":"RC"},{"code":"27681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Release Palm/finger Tendon","code_information":[{"code":"2202751","type":"CDM"},{"code":"360","type":"RC"},{"code":"26440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Tenotomy Flexor Palm Open Each Tendon","code_information":[{"code":"2202764","type":"CDM"},{"code":"360","type":"RC"},{"code":"26450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Release Of Big Toe","code_information":[{"code":"2202766","type":"CDM"},{"code":"360","type":"RC"},{"code":"28240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Incision Of Toe Tendon","code_information":[{"code":"2202775","type":"CDM"},{"code":"360","type":"RC"},{"code":"28232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Tissue Cultured Epidermal Autograft","code_information":[{"code":"2202797","type":"CDM"},{"code":"360","type":"RC"},{"code":"15157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Tiss Grafts Oth Eg Paratenon Fat Dermis","code_information":[{"code":"2202799","type":"CDM"},{"code":"360","type":"RC"},{"code":"20926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Cervix","code_information":[{"code":"2202821","type":"CDM"},{"code":"360","type":"RC"},{"code":"57530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Incision Of Spinal Nerve","code_information":[{"code":"2202824","type":"CDM"},{"code":"360","type":"RC"},{"code":"64772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Transfer Or Transplant Single Tendon","code_information":[{"code":"2202828","type":"CDM"},{"code":"360","type":"RC"},{"code":"27692","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treatment Incomplete Abortion Surgically","code_information":[{"code":"2202851","type":"CDM"},{"code":"360","type":"RC"},{"code":"59812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Treat Thigh Fracture","code_information":[{"code":"2202853","type":"CDM"},{"code":"360","type":"RC"},{"code":"27245","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Revise Middle Ear & Mastoid","code_information":[{"code":"2202869","type":"CDM"},{"code":"360","type":"RC"},{"code":"69642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":2196,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2196},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Create Eardrum Opening","code_information":[{"code":"2202875","type":"CDM"},{"code":"360","type":"RC"},{"code":"69436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Unlisted Laparoscopic Procedure Liver","code_information":[{"code":"2202883","type":"CDM"},{"code":"360","type":"RC"},{"code":"47379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Laparoscope Proc Biliary","code_information":[{"code":"2202887","type":"CDM"},{"code":"360","type":"RC"},{"code":"47579","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Laparo Proc Hernia Repair","code_information":[{"code":"2202891","type":"CDM"},{"code":"360","type":"RC"},{"code":"49659","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Laparo Proc Spermatic Cord","code_information":[{"code":"2202895","type":"CDM"},{"code":"360","type":"RC"},{"code":"55559","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1232,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Procedure Accessory Sinuses","code_information":[{"code":"2202900","type":"CDM"},{"code":"360","type":"RC"},{"code":"31299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Genital Surgery Procedure","code_information":[{"code":"2202908","type":"CDM"},{"code":"360","type":"RC"},{"code":"58999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Procedure Femur Or Knee","code_information":[{"code":"2202910","type":"CDM"},{"code":"360","type":"RC"},{"code":"27599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Procedure Hands Or Fingers","code_information":[{"code":"2202914","type":"CDM"},{"code":"360","type":"RC"},{"code":"26989","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Procedure Male Genital System","code_information":[{"code":"2202920","type":"CDM"},{"code":"360","type":"RC"},{"code":"55899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Procedure Stomach","code_information":[{"code":"2202934","type":"CDM"},{"code":"360","type":"RC"},{"code":"43999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":924,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Removal Of Sperm Duct(s)","code_information":[{"code":"2202958","type":"CDM"},{"code":"360","type":"RC"},{"code":"55250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1058,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Vulvectomy Simple Partial","code_information":[{"code":"2202978","type":"CDM"},{"code":"360","type":"RC"},{"code":"56620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":1665,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Xenograft Skin Dermal/temp Wound Close","code_information":[{"code":"2202980","type":"CDM"},{"code":"360","type":"RC"},{"code":"15420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Or Level 2 Each Add Min","code_information":[{"code":"2202987","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202987","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":138,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Progesterone","code_information":[{"code":"8400569","type":"CDM"},{"code":"300","type":"RC"},{"code":"84144","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Antibody Virus Not Elsewhere Specified","code_information":[{"code":"4000051","type":"CDM"},{"code":"300","type":"RC"},{"code":"86790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Iv Catheter Introcan 24gx3/4","code_information":[{"code":"8401221","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CAT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAT"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Iv Catheter Introcan Safety 18g","code_information":[{"code":"8401222","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CAT2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAT2"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Iv Catheter Introcan Safety 16g","code_information":[{"code":"8401223","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CAT4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAT4"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Iv Catheter Introcan 14g","code_information":[{"code":"8401224","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CAT5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAT5"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Suction Catheter Kit 14 Fr","code_information":[{"code":"8401225","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CAT6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAT6"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Cath Kit Ureth Female 8 Fr","code_information":[{"code":"8401226","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CAT7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAT7"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Cath Kit Soft Pediatric 5 R","code_information":[{"code":"8401227","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CAT8"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAT8"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Iv Catheter Introcan Safety 20gx1","code_information":[{"code":"8500803","type":"CDM"},{"code":"A4649","type":"HCPCS","modifier":"CAT1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAT1"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Stress Test Treadmill Or Bicycle","code_information":[{"code":"4200021","type":"CDM"},{"code":"730","type":"RC"},{"code":"93018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Antibody Chlamydia","code_information":[{"code":"4000021","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Antibody Cryptococcus","code_information":[{"code":"4000022","type":"CDM"},{"code":"300","type":"RC"},{"code":"86641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Antb Chlamydia","code_information":[{"code":"8400657","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Cryptococcus Antibody","code_information":[{"code":"8400658","type":"CDM"},{"code":"300","type":"RC"},{"code":"86641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Iaadiadoo Neisseria Gonorrhoeae","code_information":[{"code":"8400782","type":"CDM"},{"code":"300","type":"RC"},{"code":"87850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Potassium Serum","code_information":[{"code":"4000321","type":"CDM"},{"code":"300","type":"RC"},{"code":"84132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Prealbumin","code_information":[{"code":"4000323","type":"CDM"},{"code":"300","type":"RC"},{"code":"84134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Assay Of Phosphorus","code_information":[{"code":"8400565","type":"CDM"},{"code":"300","type":"RC"},{"code":"84100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Potassium Serum Plasma/whole Blood","code_information":[{"code":"8400566","type":"CDM"},{"code":"300","type":"RC"},{"code":"84132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Potassium Urine","code_information":[{"code":"8400567","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Assay Of Prealbumin","code_information":[{"code":"8400568","type":"CDM"},{"code":"300","type":"RC"},{"code":"84134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Sodium Urine","code_information":[{"code":"8400579","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Gases Blood Send Out","code_information":[{"code":"4000156","type":"CDM"},{"code":"300","type":"RC"},{"code":"82805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Gases Blood Ph Only","code_information":[{"code":"4000157","type":"CDM"},{"code":"300","type":"RC"},{"code":"82800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Gases Bld Ph Only","code_information":[{"code":"8400532","type":"CDM"},{"code":"300","type":"RC"},{"code":"82800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Blood Gases W/o2 Saturation","code_information":[{"code":"8400534","type":"CDM"},{"code":"300","type":"RC"},{"code":"82805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Endotracheal Tube (Ett) 7.0","code_information":[{"code":"8401164","type":"CDM"},{"code":"270","type":"RC"},{"code":"99070","type":"CPT","modifier":"ETT7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ETT7"],"minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Strapping Of Elbow Or Wrist","code_information":[{"code":"8500245","type":"CDM"},{"code":"29260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":137,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Strapping Shoulder","code_information":[{"code":"8500244","type":"CDM"},{"code":"29240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":136,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Strapping Of Hip","code_information":[{"code":"8500249","type":"CDM"},{"code":"29520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":136,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Osmolality Urine","code_information":[{"code":"4000302","type":"CDM"},{"code":"300","type":"RC"},{"code":"83935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":136,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Assay Of Urine Osmolality","code_information":[{"code":"8400561","type":"CDM"},{"code":"300","type":"RC"},{"code":"83935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":136,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Particle Agglutination Titer Ea Antibody","code_information":[{"code":"4000306","type":"CDM"},{"code":"300","type":"RC"},{"code":"86406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":135,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Part Agglut Antibody Titer","code_information":[{"code":"8400645","type":"CDM"},{"code":"300","type":"RC"},{"code":"86406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":135,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Endo Assay Seven Anal","code_information":[{"code":"8400488","type":"CDM"},{"code":"300","type":"RC"},{"code":"81506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":135,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Chlorothiazide Sodium Inj Per 500mg","code_information":[{"code":"8400892","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":135,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Blood Count Automated Diff Wbc Count","code_information":[{"code":"4000063","type":"CDM"},{"code":"300","type":"RC"},{"code":"85004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":135,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Automated Diff Wbc Count","code_information":[{"code":"8400605","type":"CDM"},{"code":"300","type":"RC"},{"code":"85004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":135,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Par/cutting Benign Hyperkeratotic Lsn Sg","code_information":[{"code":"8500080","type":"CDM"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":924,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Hydromorphone 0.2mg/1ml Pca Syr","code_information":[{"code":"3060745","type":"CDM"},{"code":"258","type":"RC"},{"code":"61553063768","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":135,"maximum":135,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Urinalysis test","code_information":[{"code":"4000277","type":"CDM"},{"code":"301","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"4000385","type":"CDM"},{"code":"301","type":"RC"},{"code":"81000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Urinalysis test","code_information":[{"code":"4000386","type":"CDM"},{"code":"301","type":"RC"},{"code":"81002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"8400479","type":"CDM"},{"code":"301","type":"RC"},{"code":"81000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Urinalysis test","code_information":[{"code":"8400481","type":"CDM"},{"code":"301","type":"RC"},{"code":"81002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Urinalysis test","code_information":[{"code":"8400482","type":"CDM"},{"code":"301","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Debrdmnt Subq Tissue 1st 20 Sq Cm/<","code_information":[{"code":"8500079","type":"CDM"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":1058,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Dextran 75 Infusion","code_information":[{"code":"8401028","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Morphine Sulfate Im/iv/sc Up To 10mg","code_information":[{"code":"8400926","type":"CDM"},{"code":"636","type":"RC"},{"code":"40918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fentanyl Citrate Injeciton 0.1mg","code_information":[{"code":"8400951","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Ketamine Up To 40mg","code_information":[{"code":"8400990","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Neomycin Hydrocortisone Otic Drops","code_information":[{"code":"8401001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zithromax/azithromycin Dihydrat Po 500mg","code_information":[{"code":"8401021","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Zithromax/ Azithromycin Up To 500mg","code_information":[{"code":"8401093","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Zithromax / Azithromycin Up To 500mg","code_information":[{"code":"8401154","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"ZITH"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ZITH"],"minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Antibody Plasmodium Malaria","code_information":[{"code":"4000041","type":"CDM"},{"code":"300","type":"RC"},{"code":"86750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Malaria Antibody","code_information":[{"code":"8400681","type":"CDM"},{"code":"300","type":"RC"},{"code":"86750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Control Nasal Hemorrhage Anterior Complx","code_information":[{"code":"8500259","type":"CDM"},{"code":"30903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":924,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Abdominal Pad","code_information":[{"code":"8401332","type":"CDM"},{"code":"450","type":"RC"},{"code":"L1270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Urea Nitrogen Quantitative","code_information":[{"code":"4000381","type":"CDM"},{"code":"300","type":"RC"},{"code":"84520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Zinc","code_information":[{"code":"4000394","type":"CDM"},{"code":"300","type":"RC"},{"code":"84630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Urea N Quan","code_information":[{"code":"8400597","type":"CDM"},{"code":"300","type":"RC"},{"code":"84520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Assay Of Zinc","code_information":[{"code":"8400600","type":"CDM"},{"code":"300","type":"RC"},{"code":"84630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"C-peptide","code_information":[{"code":"8400601","type":"CDM"},{"code":"300","type":"RC"},{"code":"84681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Oxygen Probe Used W Oximeter","code_information":[{"code":"8401208","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":134,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Assay Of Lead","code_information":[{"code":"8400553","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":133,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Moderate Sedation Services","code_information":[{"code":"8500405","type":"CDM"},{"code":"99151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":132,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Intro Needle For Dialysis Cannula Fistul","code_information":[{"code":"2201588","type":"CDM"},{"code":"300","type":"RC"},{"code":"36145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":132,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Splint","code_information":[{"code":"8401206","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":132,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Ortho Glass 4 Special Casting Material","code_information":[{"code":"8401207","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":132,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Splint Supplies Misc","code_information":[{"code":"8401359","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":132,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Cefotaxime Sodium Injection","code_information":[{"code":"8400877","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":131,"gross_charge":164,"discounted_cash":164,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cast Sup Sht Arm Splint Plst Adult","code_information":[{"code":"8401350","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":131,"gross_charge":164,"discounted_cash":164,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Dressing Change Under Anesthesia","code_information":[{"code":"8500131","type":"CDM"},{"code":"15852","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":924,"gross_charge":164,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Alteplase Recombinant","code_information":[{"code":"8400950","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":130,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Culture Bacterial Stool Aerobic","code_information":[{"code":"4000112","type":"CDM"},{"code":"300","type":"RC"},{"code":"87046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":130,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Atomic Absorption Spectroscopy Ea Analyt","code_information":[{"code":"4000057","type":"CDM"},{"code":"300","type":"RC"},{"code":"82190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":130,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Atomic Absrpj Spectroscopy Ea Anal","code_information":[{"code":"8400495","type":"CDM"},{"code":"300","type":"RC"},{"code":"82190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":130,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Norflexorphenadrine Up To 60mg","code_information":[{"code":"8400931","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":129,"gross_charge":161,"discounted_cash":161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Creactive Protein","code_information":[{"code":"4000101","type":"CDM"},{"code":"300","type":"RC"},{"code":"86140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":129,"gross_charge":161,"discounted_cash":161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Intro Ndl/intracath Vein","code_information":[{"code":"8500272","type":"CDM"},{"code":"36000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":129,"gross_charge":161,"discounted_cash":161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Rem Fb Ext Eye Conjunctival Superficial","code_information":[{"code":"8500334","type":"CDM"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":129,"gross_charge":161,"discounted_cash":161,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Administration Influenza Virus Vaccine","code_information":[{"code":"8400430","type":"CDM"},{"code":"450","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":128,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Adminsitration Pneumococcal Vaccine","code_information":[{"code":"8400431","type":"CDM"},{"code":"450","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":128,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Adminsitration Hepatitis B Vaccine","code_information":[{"code":"8400432","type":"CDM"},{"code":"450","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":128,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Culture Typing Other Methods","code_information":[{"code":"4000121","type":"CDM"},{"code":"300","type":"RC"},{"code":"87158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":128,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Cholesterol Serum Or Whole Blood Total","code_information":[{"code":"4000090","type":"CDM"},{"code":"300","type":"RC"},{"code":"82465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":128,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Gammaglobulin Iga Igd Igg Igm Each","code_information":[{"code":"4000154","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":128,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Osmolality Blood","code_information":[{"code":"4000301","type":"CDM"},{"code":"300","type":"RC"},{"code":"83930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":127,"gross_charge":159,"discounted_cash":159,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Assay Of Blood Osmolality","code_information":[{"code":"8400560","type":"CDM"},{"code":"300","type":"RC"},{"code":"83930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":127,"gross_charge":159,"discounted_cash":159,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Antibody Parvovirus","code_information":[{"code":"4000040","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":127,"gross_charge":159,"discounted_cash":159,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Antibody Mumps","code_information":[{"code":"8400679","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":127,"gross_charge":159,"discounted_cash":159,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Parvovirus Antibody","code_information":[{"code":"8400680","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":127,"gross_charge":159,"discounted_cash":159,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Column Chromatography/mass Spectrometry","code_information":[{"code":"4000095","type":"CDM"},{"code":"300","type":"RC"},{"code":"82541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":158,"discounted_cash":158,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Col-chr/ms Qual 1 Stationary&mobile Phs","code_information":[{"code":"8400516","type":"CDM"},{"code":"300","type":"RC"},{"code":"82541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":158,"discounted_cash":158,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Underarm Springassist Crutch","code_information":[{"code":"8401321","type":"CDM"},{"code":"450","type":"RC"},{"code":"E0117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":158,"discounted_cash":158,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Transferrin","code_information":[{"code":"4000371","type":"CDM"},{"code":"300","type":"RC"},{"code":"84466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":158,"discounted_cash":158,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Additional Vaccine","code_information":[{"code":"3100011","type":"CDM"},{"code":"260","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":195,"gross_charge":158,"discounted_cash":158,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Antibody Ehrlichia","code_information":[{"code":"4000025","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Kneeko Immobilizer Canvas Longit","code_information":[{"code":"8401333","type":"CDM"},{"code":"450","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Reposition Gastrostomy Tube","code_information":[{"code":"8500295","type":"CDM"},{"code":"43761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":924,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Inf Agent Detection Enterococcus Specie","code_information":[{"code":"4000245","type":"CDM"},{"code":"300","type":"RC"},{"code":"87500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Infect Agent Detection By Nucleic Acid","code_information":[{"code":"8400755","type":"CDM"},{"code":"300","type":"RC"},{"code":"87500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Levofloxacin 500mg In 100ml 5% Dex","code_information":[{"code":"3000142","type":"CDM"},{"code":"636","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Strapping Hand/finger","code_information":[{"code":"8500246","type":"CDM"},{"code":"29280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Levaquinlevofloxacin Injection 250mg","code_information":[{"code":"8400920","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":126,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Moderate Sedation Initial 15 Min 5yrs+","code_information":[{"code":"8500408","type":"CDM"},{"code":"99156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":125,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Cast Sup Sht Arm Splint Fbrg Adult","code_information":[{"code":"8401351","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":125,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Splint Wrist Or Ankle Prefabricated","code_information":[{"code":"8401367","type":"CDM"},{"code":"450","type":"RC"},{"code":"S8451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":125,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"6100019","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":125,"maximum":225,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Repair Complex Trunk Each Add 5 Cm/<","code_information":[{"code":"8500121","type":"CDM"},{"code":"13102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":924,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Antibody West Nile Virus","code_information":[{"code":"8400692","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":124,"maximum":124,"gross_charge":155,"discounted_cash":155,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Immunoassay Nonantibody","code_information":[{"code":"8400545","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":123,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Miscellaneous Pathology Test","code_information":[{"code":"4000380","type":"CDM"},{"code":"300","type":"RC"},{"code":"89240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":123,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Pathology Lab Procedure","code_information":[{"code":"8400794","type":"CDM"},{"code":"300","type":"RC"},{"code":"89240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":123,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Propofol 1000mg/100ml","code_information":[{"code":"3000251","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":123,"maximum":123,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":123}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Influ Virus Vacc Split Prsrv Fr 3 Yr +Im","code_information":[{"code":"8400820","type":"CDM"},{"code":"250","type":"RC"},{"code":"90656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":122,"gross_charge":153,"discounted_cash":153,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Blood Occult Perox Act Qual Fcs 1-3 Spec","code_information":[{"code":"8400501","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":122,"gross_charge":153,"discounted_cash":153,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Fluorescent Noninfectious Agent Antibody","code_information":[{"code":"8400637","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":122,"gross_charge":153,"discounted_cash":153,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Catheterization Bladder","code_information":[{"code":"8500303","type":"CDM"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":924,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Inhalation Treatmenteach Addt`l Hr","code_information":[{"code":"8400379","type":"CDM"},{"code":"410","type":"RC"},{"code":"94645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":210,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Oral Magnetic Res Contrast Per 100ml","code_information":[{"code":"8401109","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q9954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":120,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Glucose Body Fluid Other Than Blood","code_information":[{"code":"4000161","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":120,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Ova And Parasites Direct Smears Conc","code_information":[{"code":"4000303","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":120,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Us Abdominal Rt W/img Doc Limited","code_information":[{"code":"8501378","type":"CDM"},{"code":"76705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":120,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Hospital Observation Service Per Hour","code_information":[{"code":"100002","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":2800,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2800}]}]},{"description":"Injection, Promethazine Hcl, Up To 50 Mg","code_information":[{"code":"3001127","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":120,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Crm Setup Training","code_information":[{"code":"6100009","type":"CDM"},{"code":"420","type":"RC"},{"code":"97039","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":120,"maximum":225,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Injection, Haloperidol, Up To 5 Mg","code_information":[{"code":"30000127","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":120,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Crm Setup Training","code_information":[{"code":"61000075","type":"CDM"},{"code":"420","type":"RC"},{"code":"97039","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":120,"maximum":225,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Crm Setup Training","code_information":[{"code":"61000076","type":"CDM"},{"code":"420","type":"RC"},{"code":"97039","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":120,"maximum":225,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Electrical Stimulation (Unattended), To","code_information":[{"code":"6100045","type":"CDM"},{"code":"424","type":"RC"},{"code":"G0283","type":"HCPCS","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":120,"maximum":225,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Electrical Stimulation (Unattended), To","code_information":[{"code":"6100046","type":"CDM"},{"code":"424","type":"RC"},{"code":"G0283","type":"HCPCS","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":120,"maximum":225,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Surgifoam 110-10 Absorbable Hemostat","code_information":[{"code":"3000293","type":"CDM"},{"code":"250","type":"RC"},{"code":"63713001972","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":119,"maximum":119,"gross_charge":149,"discounted_cash":149,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Path Consultation During Cytologic Exam","code_information":[{"code":"4000308","type":"CDM"},{"code":"310","type":"RC"},{"code":"88334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":119,"gross_charge":149,"discounted_cash":149,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119}]}]},{"description":"Cast Sup Long Leg Fiberglass Adult 11yr+","code_information":[{"code":"8401354","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":118,"gross_charge":148,"discounted_cash":148,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118}]}]},{"description":"Anoscopy Inc Collection Of Specimen","code_information":[{"code":"8400300","type":"CDM"},{"code":"360","type":"RC"},{"code":"46600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":924,"gross_charge":148,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118}]}]},{"description":"Albuterol Sulfate Inhaler Aerosol 90 Mcg","code_information":[{"code":"3000011","type":"CDM"},{"code":"636","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":118,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Folic Acid Serum","code_information":[{"code":"8400529","type":"CDM"},{"code":"300","type":"RC"},{"code":"82746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":117,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Arthrocentesis Aspir&/inj Inter Jt/bursa","code_information":[{"code":"8500148","type":"CDM"},{"code":"20606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":924,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Pulse Ox -N-invs Ear/pls Ox F/o2sat1 Dtr","code_information":[{"code":"8400380","type":"CDM"},{"code":"410","type":"RC"},{"code":"94760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":116,"maximum":210,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Assay Of Ferritin","code_information":[{"code":"8400527","type":"CDM"},{"code":"300","type":"RC"},{"code":"82728","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":116,"maximum":116,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":116}]}]},{"description":"Gammaglobulin Immunoglobulin","code_information":[{"code":"8400531","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":116,"maximum":116,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":116}]}]},{"description":"Penicil G Benzathine/ Bicillin Inj 1.2ml","code_information":[{"code":"8400868","type":"CDM"},{"code":"450","type":"RC"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Glucose Post Glucose Dose Includes Gluco","code_information":[{"code":"4000163","type":"CDM"},{"code":"300","type":"RC"},{"code":"82950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Glucose Quantitative Blood Except Reagen","code_information":[{"code":"4000164","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Collagen Cross Links Any Method","code_information":[{"code":"8400512","type":"CDM"},{"code":"300","type":"RC"},{"code":"82497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Glucose Other Fluid","code_information":[{"code":"8400535","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Gluc Quan Bld","code_information":[{"code":"8400536","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Glucose Other Fluid","code_information":[{"code":"8400538","type":"CDM"},{"code":"300","type":"RC"},{"code":"82950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Molecular Pathology Procedure Level 1 Id","code_information":[{"code":"4000298","type":"CDM"},{"code":"300","type":"RC"},{"code":"81400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Blood Collection Tube Vacuum Dlys Per 50","code_information":[{"code":"8400487","type":"CDM"},{"code":"300","type":"RC"},{"code":"81400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Strapping Ankle &/Foot","code_information":[{"code":"8500251","type":"CDM"},{"code":"29540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Strapping Unna Boot","code_information":[{"code":"8500253","type":"CDM"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":300,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Abd Paracentesis W/o Img Guidance Add 1","code_information":[{"code":"2200001","type":"CDM"},{"code":"360","type":"RC"},{"code":"49082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tis Trnfr Any 30.1-60 Sq Cm Add","code_information":[{"code":"2200011","type":"CDM"},{"code":"360","type":"RC"},{"code":"14301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Adjacent Tissue Transfer/rearrangement A","code_information":[{"code":"2200013","type":"CDM"},{"code":"360","type":"RC"},{"code":"14302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tis Trnfr Trnk 10 Sq Cm/< Add","code_information":[{"code":"2200015","type":"CDM"},{"code":"360","type":"RC"},{"code":"14000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tis Trnfr E/n/e/l 10 Sq Cm/< Add","code_information":[{"code":"2200017","type":"CDM"},{"code":"360","type":"RC"},{"code":"14060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tis Trnfr S/a/l 10 Sq Cm/< Add","code_information":[{"code":"2200023","type":"CDM"},{"code":"360","type":"RC"},{"code":"14020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tis Trnfr S/a/l 10.1-30 Sqcm Add","code_information":[{"code":"2200025","type":"CDM"},{"code":"360","type":"RC"},{"code":"14021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tis Trnfr Trunk 10.1-30sqcm Add","code_information":[{"code":"2200027","type":"CDM"},{"code":"360","type":"RC"},{"code":"14001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Anorectal Exam Req Anes Dx Add 1 Min","code_information":[{"code":"2200055","type":"CDM"},{"code":"360","type":"RC"},{"code":"45990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Apply Bone Fixation Device Add","code_information":[{"code":"2200077","type":"CDM"},{"code":"360","type":"RC"},{"code":"20692","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Apply Bone Fixation Device Add","code_information":[{"code":"2200079","type":"CDM"},{"code":"360","type":"RC"},{"code":"20690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"App Finger Splint Static Add","code_information":[{"code":"2200083","type":"CDM"},{"code":"940","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":300,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"App Short Arm Splint Frarm-hnd Static A","code_information":[{"code":"2200085","type":"CDM"},{"code":"360","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Application Of Short Leg Splint","code_information":[{"code":"2200087","type":"CDM"},{"code":"940","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":300,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Drain/inj Int Joint/bursa W/us Add","code_information":[{"code":"2200104","type":"CDM"},{"code":"360","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drain/inj Mjr Joint/bursa W/us Add","code_information":[{"code":"2200106","type":"CDM"},{"code":"360","type":"RC"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drain/inj Sm Joint/bursa W/us Add","code_information":[{"code":"2200108","type":"CDM"},{"code":"360","type":"RC"},{"code":"20604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drain/inj Mjr Joint/bursa W/o Us Add","code_information":[{"code":"2200110","type":"CDM"},{"code":"360","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drain/inj Joint/bursa W/o Us Add","code_information":[{"code":"2200112","type":"CDM"},{"code":"360","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Arthroplast W/pros Replace Dist Rad Add","code_information":[{"code":"2200176","type":"CDM"},{"code":"360","type":"RC"},{"code":"25441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1665,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Arthroscopy Wrist Synovectomy Cmp","code_information":[{"code":"2200285","type":"CDM"},{"code":"360","type":"RC"},{"code":"29845","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Explore/treat Hand Joint","code_information":[{"code":"2200309","type":"CDM"},{"code":"360","type":"RC"},{"code":"26070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Explore/treat Finger Joint","code_information":[{"code":"2200311","type":"CDM"},{"code":"360","type":"RC"},{"code":"26080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1508,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Asp & Inj For Tx Bone Cyst","code_information":[{"code":"2200317","type":"CDM"},{"code":"360","type":"RC"},{"code":"20615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Aspiration And/or Inj Thyroid Cyst","code_information":[{"code":"2200321","type":"CDM"},{"code":"360","type":"RC"},{"code":"60300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Of Nail Plate","code_information":[{"code":"2200335","type":"CDM"},{"code":"360","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Bx Anorectal Wall Congenital Megacolon","code_information":[{"code":"2200344","type":"CDM"},{"code":"360","type":"RC"},{"code":"45100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Biopsy Liver Wedge","code_information":[{"code":"2200352","type":"CDM"},{"code":"360","type":"RC"},{"code":"47100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Bx Hyponychium Prox & Lat Nail Folds Add","code_information":[{"code":"2200354","type":"CDM"},{"code":"360","type":"RC"},{"code":"11755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Biopsy Palate Uvula Add","code_information":[{"code":"2200356","type":"CDM"},{"code":"360","type":"RC"},{"code":"42100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Biop/exc Lymph Nodes Open Superf Add 15","code_information":[{"code":"2200372","type":"CDM"},{"code":"360","type":"RC"},{"code":"38500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Bx Bone Trocar Ndl Deep Verte Bdy Femr","code_information":[{"code":"2200377","type":"CDM"},{"code":"360","type":"RC"},{"code":"20225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Biopsy of prostate gland","code_information":[{"code":"2200381","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Biopsy Oropharynx Add","code_information":[{"code":"2200393","type":"CDM"},{"code":"360","type":"RC"},{"code":"42800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Bone Marrow Biopsy Needle Or Trocar Add","code_information":[{"code":"2200414","type":"CDM"},{"code":"360","type":"RC"},{"code":"38221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Dx Bronchoscope/wash Add","code_information":[{"code":"2200423","type":"CDM"},{"code":"360","type":"RC"},{"code":"31622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Carpectomy One Bone Add","code_information":[{"code":"2200447","type":"CDM"},{"code":"360","type":"RC"},{"code":"25210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Change Gastrostomy Tube Percutaneous","code_information":[{"code":"2200467","type":"CDM"},{"code":"360","type":"RC"},{"code":"43760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Treat Fracture Radius/ulna","code_information":[{"code":"2200498","type":"CDM"},{"code":"360","type":"RC"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Closed Tx Nasal Bone Frctr W/o Stabil","code_information":[{"code":"2200514","type":"CDM"},{"code":"360","type":"RC"},{"code":"21315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Treat Fracture Radius & Ulna","code_information":[{"code":"2200520","type":"CDM"},{"code":"360","type":"RC"},{"code":"25565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Closed Tx Rad Shaft Fract W/manip","code_information":[{"code":"2200526","type":"CDM"},{"code":"360","type":"RC"},{"code":"25505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Colposcopy Cervix Inc Up/adj Vagina","code_information":[{"code":"2200570","type":"CDM"},{"code":"360","type":"RC"},{"code":"57452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Colpotomy With Exploration","code_information":[{"code":"2200576","type":"CDM"},{"code":"360","type":"RC"},{"code":"57000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Computer-assisted Navi Pro Musculo Img","code_information":[{"code":"2200582","type":"CDM"},{"code":"360","type":"RC"},{"code":"20985","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Contrast Inj Rad Eval Cent Ven Cath","code_information":[{"code":"2200591","type":"CDM"},{"code":"360","type":"RC"},{"code":"36598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Debride Skin At Fx Site","code_information":[{"code":"2200720","type":"CDM"},{"code":"360","type":"RC"},{"code":"11010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Debride Skin Musc At Fx Site","code_information":[{"code":"2200722","type":"CDM"},{"code":"360","type":"RC"},{"code":"11011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Deb Skin Bone At Fx Site","code_information":[{"code":"2200724","type":"CDM"},{"code":"360","type":"RC"},{"code":"11012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Debridement Extensive Eczematous","code_information":[{"code":"2200728","type":"CDM"},{"code":"360","type":"RC"},{"code":"11001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Debride Ext Eczemat/inf Skin>10% Body","code_information":[{"code":"2200730","type":"CDM"},{"code":"360","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Debride Genitalia & Perineum","code_information":[{"code":"2200734","type":"CDM"},{"code":"360","type":"RC"},{"code":"11004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Debrd Subq Tissue Incl Epiderm/dermis","code_information":[{"code":"2200736","type":"CDM"},{"code":"360","type":"RC"},{"code":"11045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Debridement Skin&subcutaneous Tissue","code_information":[{"code":"2200746","type":"CDM"},{"code":"360","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Destruct Paravertebral Facet Joint Nrv","code_information":[{"code":"2200776","type":"CDM"},{"code":"360","type":"RC"},{"code":"64634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Destroy Cerv/thor Facet Jnt","code_information":[{"code":"2200778","type":"CDM"},{"code":"360","type":"RC"},{"code":"64633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Dstrj Nulyt Agt Gnclr Nrv","code_information":[{"code":"2200780","type":"CDM"},{"code":"360","type":"RC"},{"code":"64624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Destruct Paravertebral Facet Joint Nrv","code_information":[{"code":"2200782","type":"CDM"},{"code":"360","type":"RC"},{"code":"64636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Destroy Lumb/sac Facet Jnt","code_information":[{"code":"2200784","type":"CDM"},{"code":"360","type":"RC"},{"code":"64635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Injection Treatment Of Nerve","code_information":[{"code":"2200786","type":"CDM"},{"code":"360","type":"RC"},{"code":"64640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Destruction Penis Lesion(s)","code_information":[{"code":"2200796","type":"CDM"},{"code":"360","type":"RC"},{"code":"54050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drain Abscess/hemat Nasal Int Appr","code_information":[{"code":"2200831","type":"CDM"},{"code":"360","type":"RC"},{"code":"30000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drainage Finger Abscess Comp","code_information":[{"code":"2200837","type":"CDM"},{"code":"360","type":"RC"},{"code":"26011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drainage Finger Abscess Simple","code_information":[{"code":"2200839","type":"CDM"},{"code":"360","type":"RC"},{"code":"26010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drainage Scrotal Wall Abscess","code_information":[{"code":"2200845","type":"CDM"},{"code":"360","type":"RC"},{"code":"55100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drain Tend Sheath Dgt &/Or Plm Ea","code_information":[{"code":"2200847","type":"CDM"},{"code":"360","type":"RC"},{"code":"26020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Ercp Duct Stent Placement","code_information":[{"code":"2200881","type":"CDM"},{"code":"360","type":"RC"},{"code":"43274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Interlaminar Crv/thrc","code_information":[{"code":"2200897","type":"CDM"},{"code":"360","type":"RC"},{"code":"62325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Interlaminar Crv/thrc","code_information":[{"code":"2200899","type":"CDM"},{"code":"360","type":"RC"},{"code":"62324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Interlaminar Crv/thrc","code_information":[{"code":"2200901","type":"CDM"},{"code":"360","type":"RC"},{"code":"62321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Interlaminar Crv/thrc","code_information":[{"code":"2200903","type":"CDM"},{"code":"360","type":"RC"},{"code":"62320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Interlaminar Lmbr/sac","code_information":[{"code":"2200905","type":"CDM"},{"code":"360","type":"RC"},{"code":"62327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"2200907","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Interlaminar Lmbr/sac","code_information":[{"code":"2200909","type":"CDM"},{"code":"360","type":"RC"},{"code":"62326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"2200911","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Esophagoscopy Rigid Balloon","code_information":[{"code":"2200917","type":"CDM"},{"code":"360","type":"RC"},{"code":"43195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Esophagoscopy Flexible Brush","code_information":[{"code":"2200919","type":"CDM"},{"code":"360","type":"RC"},{"code":"43200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Esophagoscopy Flex Biopsy","code_information":[{"code":"2200921","type":"CDM"},{"code":"360","type":"RC"},{"code":"43202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Esophagoscopy Rigid Trnso Dx","code_information":[{"code":"2200923","type":"CDM"},{"code":"360","type":"RC"},{"code":"43191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Evacuation Subungual Hematoma","code_information":[{"code":"2200925","type":"CDM"},{"code":"360","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove External Ear Partial","code_information":[{"code":"2200935","type":"CDM"},{"code":"360","type":"RC"},{"code":"69110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Excision Breast Lesion","code_information":[{"code":"2200943","type":"CDM"},{"code":"360","type":"RC"},{"code":"19125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Of Nail Bed","code_information":[{"code":"2200987","type":"CDM"},{"code":"360","type":"RC"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Sweat Gland Lesion","code_information":[{"code":"2201014","type":"CDM"},{"code":"360","type":"RC"},{"code":"11451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Sweat Gland Lesion","code_information":[{"code":"2201018","type":"CDM"},{"code":"360","type":"RC"},{"code":"11471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Sweat Gland Lesion","code_information":[{"code":"2201020","type":"CDM"},{"code":"360","type":"RC"},{"code":"11470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Of Knee Cyst","code_information":[{"code":"2201026","type":"CDM"},{"code":"360","type":"RC"},{"code":"27345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1508,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Of Urethra Lesion","code_information":[{"code":"2201031","type":"CDM"},{"code":"360","type":"RC"},{"code":"53230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Ear Canal Lesion(s)","code_information":[{"code":"2201069","type":"CDM"},{"code":"360","type":"RC"},{"code":"69145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Thigh/knee Tum Dep 5cm/>","code_information":[{"code":"2201093","type":"CDM"},{"code":"360","type":"RC"},{"code":"27339","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc H-f-nk-sp B9+marg 0.5/<","code_information":[{"code":"2201105","type":"CDM"},{"code":"360","type":"RC"},{"code":"11420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc H-f-nk-sp B9+marg 0.6-1","code_information":[{"code":"2201107","type":"CDM"},{"code":"360","type":"RC"},{"code":"11421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc H-f-nk-sp B9+marg 2.1-4","code_information":[{"code":"2201111","type":"CDM"},{"code":"360","type":"RC"},{"code":"11423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc H-f-nk-sp B9+marg 3.1-5","code_information":[{"code":"2201113","type":"CDM"},{"code":"360","type":"RC"},{"code":"11424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc H-f-nk-sp B9+marg >4 Cm","code_information":[{"code":"2201115","type":"CDM"},{"code":"360","type":"RC"},{"code":"11426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext B9+marg 0.5 Cm<","code_information":[{"code":"2201117","type":"CDM"},{"code":"360","type":"RC"},{"code":"11400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext B9+marg 0.6-1 Cm","code_information":[{"code":"2201119","type":"CDM"},{"code":"360","type":"RC"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext B9+marg 1.1-2 Cm","code_information":[{"code":"2201121","type":"CDM"},{"code":"360","type":"RC"},{"code":"11402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext B9+marg 2.1-3cm","code_information":[{"code":"2201123","type":"CDM"},{"code":"360","type":"RC"},{"code":"11403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext B9+marg 3.1-4 Cm","code_information":[{"code":"2201125","type":"CDM"},{"code":"360","type":"RC"},{"code":"11404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext B9+marg >4.0 Cm","code_information":[{"code":"2201127","type":"CDM"},{"code":"360","type":"RC"},{"code":"11406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc F/e/e/n/l Mal+mrg 0.6-1","code_information":[{"code":"2201151","type":"CDM"},{"code":"360","type":"RC"},{"code":"11641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc F/e/e/n/l Mal+mrg 1.1-2","code_information":[{"code":"2201153","type":"CDM"},{"code":"360","type":"RC"},{"code":"11642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc F/e/e/n/l Mal+mrg 3.1-4","code_information":[{"code":"2201155","type":"CDM"},{"code":"360","type":"RC"},{"code":"11644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc S/n/h/f/g Mal+mrg 1.1-2","code_information":[{"code":"2201158","type":"CDM"},{"code":"360","type":"RC"},{"code":"11622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc S/n/h/f/g Mal+mrg >4 Cm","code_information":[{"code":"2201160","type":"CDM"},{"code":"360","type":"RC"},{"code":"11626","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext Mal+marg 1.1-2 Cm","code_information":[{"code":"2201162","type":"CDM"},{"code":"360","type":"RC"},{"code":"11602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext Mal+marg 2.1-3 Cm","code_information":[{"code":"2201164","type":"CDM"},{"code":"360","type":"RC"},{"code":"11603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Tr-ext Mal+marg 3.1-4 Cm","code_information":[{"code":"2201166","type":"CDM"},{"code":"360","type":"RC"},{"code":"11604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Face-mm B9+marg 0.5 Cm/<","code_information":[{"code":"2201176","type":"CDM"},{"code":"360","type":"RC"},{"code":"11440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Face-mm B9+marg 0.6-1 Cm","code_information":[{"code":"2201178","type":"CDM"},{"code":"360","type":"RC"},{"code":"11441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Face-mm B9+marg 1.1-2 Cm","code_information":[{"code":"2201180","type":"CDM"},{"code":"360","type":"RC"},{"code":"11442","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Face-mm B9+marg 2.1-3 Cm","code_information":[{"code":"2201182","type":"CDM"},{"code":"360","type":"RC"},{"code":"11443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Face-mm B9+marg 3.1-4 Cm","code_information":[{"code":"2201184","type":"CDM"},{"code":"360","type":"RC"},{"code":"11444","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Face-mm B9+marg >4 Cm","code_information":[{"code":"2201186","type":"CDM"},{"code":"360","type":"RC"},{"code":"11446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Face Les Sbq 2 Cm/>","code_information":[{"code":"2201213","type":"CDM"},{"code":"360","type":"RC"},{"code":"21012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exc Face Les Sc <2 Cm","code_information":[{"code":"2201215","type":"CDM"},{"code":"360","type":"RC"},{"code":"21011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Explore Wound Extremity","code_information":[{"code":"2201243","type":"CDM"},{"code":"360","type":"RC"},{"code":"20103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Exploration Behind Abdomen","code_information":[{"code":"2201251","type":"CDM"},{"code":"360","type":"RC"},{"code":"49010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1508,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Fine Needle Asp W Imag Guidance","code_information":[{"code":"2201277","type":"CDM"},{"code":"360","type":"RC"},{"code":"10022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Fine Needle Asp Wo Imag Guidance","code_information":[{"code":"2201279","type":"CDM"},{"code":"360","type":"RC"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Gnclr Nrv Brnch","code_information":[{"code":"2201310","type":"CDM"},{"code":"360","type":"RC"},{"code":"64454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Treatment Of Foot Infection","code_information":[{"code":"2201379","type":"CDM"},{"code":"360","type":"RC"},{"code":"28003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drainage Of Skin Abscess","code_information":[{"code":"2201384","type":"CDM"},{"code":"360","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drainage Of Hematoma/fluid","code_information":[{"code":"2201390","type":"CDM"},{"code":"360","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Incision Of Rectal Abscess","code_information":[{"code":"2201396","type":"CDM"},{"code":"360","type":"RC"},{"code":"46060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"I&d Pilonidal Cyst Complicated","code_information":[{"code":"2201398","type":"CDM"},{"code":"360","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Drainage Of Rectal Abscess","code_information":[{"code":"2201399","type":"CDM"},{"code":"360","type":"RC"},{"code":"45005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Foreign Body","code_information":[{"code":"2201423","type":"CDM"},{"code":"360","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Foreign Body","code_information":[{"code":"2201425","type":"CDM"},{"code":"360","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Nrv Nrvtg Si Jt Add","code_information":[{"code":"2201440","type":"CDM"},{"code":"360","type":"RC"},{"code":"64451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Proc Cystograph/urethrocystography A","code_information":[{"code":"2201444","type":"CDM"},{"code":"360","type":"RC"},{"code":"51600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inject Proc Disco Ea Level Cerv/thor","code_information":[{"code":"2201446","type":"CDM"},{"code":"360","type":"RC"},{"code":"62291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Proc Discography Ea Lvl Lumbar","code_information":[{"code":"2201448","type":"CDM"},{"code":"360","type":"RC"},{"code":"62290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Proc Hip Arthrography With Anes","code_information":[{"code":"2201450","type":"CDM"},{"code":"360","type":"RC"},{"code":"27095","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Proc For Hip Arthrography W/o Anes","code_information":[{"code":"2201452","type":"CDM"},{"code":"360","type":"RC"},{"code":"27093","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inject Sacroiliac Joint","code_information":[{"code":"2201455","type":"CDM"},{"code":"360","type":"RC"},{"code":"27096","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj For Sacroiliac Jt Anesth","code_information":[{"code":"2201457","type":"CDM"},{"code":"360","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Injection Procedure Lymphangiography","code_information":[{"code":"2201461","type":"CDM"},{"code":"360","type":"RC"},{"code":"38790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"N Block Inj Plantar Digit","code_information":[{"code":"2201463","type":"CDM"},{"code":"360","type":"RC"},{"code":"64455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Paravertebral Facet Zygapop","code_information":[{"code":"2201465","type":"CDM"},{"code":"360","type":"RC"},{"code":"64491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Paravert F Jnt C/t 1 Lev","code_information":[{"code":"2201467","type":"CDM"},{"code":"360","type":"RC"},{"code":"64490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Paravrtbrl Facet Zygapophyseal Jnt","code_information":[{"code":"2201469","type":"CDM"},{"code":"360","type":"RC"},{"code":"64492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Paravertebral Joint 2nd Level","code_information":[{"code":"2201471","type":"CDM"},{"code":"360","type":"RC"},{"code":"64494","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Paravert F Jnt L/s 1 Lev","code_information":[{"code":"2201473","type":"CDM"},{"code":"360","type":"RC"},{"code":"64493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Paravrtbrl Facet Zygapophyseal Jnt","code_information":[{"code":"2201475","type":"CDM"},{"code":"360","type":"RC"},{"code":"64495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Trigger Point 1/2 Muscl","code_information":[{"code":"2201479","type":"CDM"},{"code":"360","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inject Trigger Points 3/>","code_information":[{"code":"2201481","type":"CDM"},{"code":"360","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Tendon Origin/insertion","code_information":[{"code":"2201483","type":"CDM"},{"code":"360","type":"RC"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Tendon Sheath/ligament","code_information":[{"code":"2201485","type":"CDM"},{"code":"360","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inject Anestheti Agent And/or Steroid","code_information":[{"code":"2201487","type":"CDM"},{"code":"360","type":"RC"},{"code":"64480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Foramen Epidural C/t","code_information":[{"code":"2201489","type":"CDM"},{"code":"360","type":"RC"},{"code":"64479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Agent And/or Steroid Epidural","code_information":[{"code":"2201491","type":"CDM"},{"code":"360","type":"RC"},{"code":"64484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Injection(s) of anesthetic into lower spine using imaging guidance","code_information":[{"code":"2201493","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Axillary Nrv","code_information":[{"code":"2201495","type":"CDM"},{"code":"360","type":"RC"},{"code":"64417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Brach Plexus","code_information":[{"code":"2201497","type":"CDM"},{"code":"360","type":"RC"},{"code":"64415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inj Anesthetic Agent Carotid Sinus","code_information":[{"code":"2201499","type":"CDM"},{"code":"360","type":"RC"},{"code":"64508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"N Block Inj Celiac Pelus","code_information":[{"code":"2201501","type":"CDM"},{"code":"360","type":"RC"},{"code":"64530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Fem Nerve Nfs","code_information":[{"code":"2201503","type":"CDM"},{"code":"360","type":"RC"},{"code":"64448","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Femoral Nerve","code_information":[{"code":"2201505","type":"CDM"},{"code":"360","type":"RC"},{"code":"64447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Gr Ocpl Nrv","code_information":[{"code":"2201507","type":"CDM"},{"code":"360","type":"RC"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Ii Ih Nerves","code_information":[{"code":"2201509","type":"CDM"},{"code":"360","type":"RC"},{"code":"64425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Ntrcost Nrv","code_information":[{"code":"2201511","type":"CDM"},{"code":"360","type":"RC"},{"code":"64420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inject Intercostal Nrvs Mult Reg Block","code_information":[{"code":"2201513","type":"CDM"},{"code":"360","type":"RC"},{"code":"64421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"N Block Lumbar/thoracic","code_information":[{"code":"2201515","type":"CDM"},{"code":"360","type":"RC"},{"code":"64520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Other Pn/branch","code_information":[{"code":"2201517","type":"CDM"},{"code":"360","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Sciatic Nerve","code_information":[{"code":"2201519","type":"CDM"},{"code":"360","type":"RC"},{"code":"64445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"N Block Spenopalatine Gangl","code_information":[{"code":"2201521","type":"CDM"},{"code":"360","type":"RC"},{"code":"64505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"N Block Stellate Ganglion","code_information":[{"code":"2201523","type":"CDM"},{"code":"360","type":"RC"},{"code":"64510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"N Block Inj Hypogas Plxs","code_information":[{"code":"2201525","type":"CDM"},{"code":"360","type":"RC"},{"code":"64517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Sprscap Nrv","code_information":[{"code":"2201527","type":"CDM"},{"code":"360","type":"RC"},{"code":"64418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Njx Aa&/strd Trigeminal Nrv","code_information":[{"code":"2201529","type":"CDM"},{"code":"360","type":"RC"},{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Injection Epidural Blood Or Clot Patch","code_information":[{"code":"2201531","type":"CDM"},{"code":"360","type":"RC"},{"code":"62273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inject Skin Lesions >7","code_information":[{"code":"2201533","type":"CDM"},{"code":"360","type":"RC"},{"code":"11901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Inject Skin Lesions </W 7","code_information":[{"code":"2201535","type":"CDM"},{"code":"360","type":"RC"},{"code":"11900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Ther Injection Carp Tunnel","code_information":[{"code":"2201537","type":"CDM"},{"code":"360","type":"RC"},{"code":"20526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Place Duod/jej Tube Perc","code_information":[{"code":"2201539","type":"CDM"},{"code":"360","type":"RC"},{"code":"49441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Place Gastrostomy Tube Perc","code_information":[{"code":"2201541","type":"CDM"},{"code":"360","type":"RC"},{"code":"49440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Ins Endovas Vena Cava Filtr","code_information":[{"code":"2201551","type":"CDM"},{"code":"360","type":"RC"},{"code":"37191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Insert Bladder Catheter","code_information":[{"code":"2201555","type":"CDM"},{"code":"360","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Insertion Subcutaneous Extension","code_information":[{"code":"2201563","type":"CDM"},{"code":"360","type":"RC"},{"code":"49435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Insert Tunneled Cv Cath","code_information":[{"code":"2201573","type":"CDM"},{"code":"360","type":"RC"},{"code":"36558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intraop Id Mapping Sentinel Lymph Node","code_information":[{"code":"2201584","type":"CDM"},{"code":"360","type":"RC"},{"code":"38900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Test For Blood Flow In Graft","code_information":[{"code":"2201586","type":"CDM"},{"code":"360","type":"RC"},{"code":"15860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Incise Inner Ear","code_information":[{"code":"2201591","type":"CDM"},{"code":"360","type":"RC"},{"code":"69801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1665,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Laryngoscop W/vc Inj + Scope","code_information":[{"code":"2201739","type":"CDM"},{"code":"360","type":"RC"},{"code":"31571","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Diagnostic Laryngoscopy","code_information":[{"code":"2201743","type":"CDM"},{"code":"360","type":"RC"},{"code":"31505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr Face/mm 12.6-20 Cm","code_information":[{"code":"2201754","type":"CDM"},{"code":"360","type":"RC"},{"code":"12055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr Face/mm 2.5 Cm/<","code_information":[{"code":"2201756","type":"CDM"},{"code":"360","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr Face/mm 2.6-5.0 Cm","code_information":[{"code":"2201758","type":"CDM"},{"code":"360","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr Face/mm 5.1-7.5 Cm","code_information":[{"code":"2201762","type":"CDM"},{"code":"360","type":"RC"},{"code":"12053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr N-hf/genit 2.5cm/<","code_information":[{"code":"2201764","type":"CDM"},{"code":"360","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr N-hf/genit2.6-7.5","code_information":[{"code":"2201766","type":"CDM"},{"code":"360","type":"RC"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr N-hf/genit7.6-12.5","code_information":[{"code":"2201768","type":"CDM"},{"code":"360","type":"RC"},{"code":"12044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr S/a/t/ext 2.5 Cm/<","code_information":[{"code":"2201770","type":"CDM"},{"code":"360","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr S/tr/ext 7.6-12.5","code_information":[{"code":"2201772","type":"CDM"},{"code":"360","type":"RC"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Ligation Or Biopsy Temporal Artery","code_information":[{"code":"2201782","type":"CDM"},{"code":"360","type":"RC"},{"code":"37609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Incision Of Breast Lesion","code_information":[{"code":"2201832","type":"CDM"},{"code":"360","type":"RC"},{"code":"19020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Microsurgical Techniques W/microscope","code_information":[{"code":"2201839","type":"CDM"},{"code":"360","type":"RC"},{"code":"69990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Incision Of Eardrum","code_information":[{"code":"2201857","type":"CDM"},{"code":"360","type":"RC"},{"code":"69421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Placement Breast Localization Devices","code_information":[{"code":"2202229","type":"CDM"},{"code":"360","type":"RC"},{"code":"19285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Place Ndl Musc/tis For Rt","code_information":[{"code":"2202233","type":"CDM"},{"code":"360","type":"RC"},{"code":"20555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Punch Biopsy With Simple Closer","code_information":[{"code":"2202258","type":"CDM"},{"code":"360","type":"RC"},{"code":"11104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Puncture Aspiration Of Abscess","code_information":[{"code":"2202260","type":"CDM"},{"code":"360","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Puncture Aspiration Cyst Breast","code_information":[{"code":"2202262","type":"CDM"},{"code":"360","type":"RC"},{"code":"19000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Brain Canal Shunt Procedure","code_information":[{"code":"2202264","type":"CDM"},{"code":"360","type":"RC"},{"code":"61070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Extensive Surgery Of Throat","code_information":[{"code":"2202271","type":"CDM"},{"code":"360","type":"RC"},{"code":"42842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Reconstruction Nail Bed With Graft","code_information":[{"code":"2202308","type":"CDM"},{"code":"360","type":"RC"},{"code":"11762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Clear Outer Ear Canal","code_information":[{"code":"2202338","type":"CDM"},{"code":"360","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Nasal Foreign Body","code_information":[{"code":"2202340","type":"CDM"},{"code":"360","type":"RC"},{"code":"30310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Impacted Ear Wax Uni","code_information":[{"code":"2202342","type":"CDM"},{"code":"360","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Impacted Ear Wax Uni","code_information":[{"code":"2202344","type":"CDM"},{"code":"360","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Curette/treat Cornea","code_information":[{"code":"2202352","type":"CDM"},{"code":"360","type":"RC"},{"code":"65436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Of Foreign Body Musc/tdn Spl","code_information":[{"code":"2202355","type":"CDM"},{"code":"360","type":"RC"},{"code":"20520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Intrauterine Device Iud","code_information":[{"code":"2202375","type":"CDM"},{"code":"360","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Tunneled Ip Cath","code_information":[{"code":"2202379","type":"CDM"},{"code":"360","type":"RC"},{"code":"49422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Rem Mesh Abdominal Wall For Infection","code_information":[{"code":"2202389","type":"CDM"},{"code":"360","type":"RC"},{"code":"11008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Skin Tags Mult Fibrocut","code_information":[{"code":"2202391","type":"CDM"},{"code":"360","type":"RC"},{"code":"11201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Removal Of Skin Tags <W/17","code_information":[{"code":"2202393","type":"CDM"},{"code":"360","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Sutures Diff Surgeon","code_information":[{"code":"2202401","type":"CDM"},{"code":"360","type":"RC"},{"code":"15851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Tissue Expander(s)","code_information":[{"code":"2202404","type":"CDM"},{"code":"360","type":"RC"},{"code":"11971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Repair Lip Full Thickness Vermilion Only","code_information":[{"code":"2202436","type":"CDM"},{"code":"360","type":"RC"},{"code":"40650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Cmplx Rpr E/n/e/l 1.1-2.5 Cm","code_information":[{"code":"2202514","type":"CDM"},{"code":"360","type":"RC"},{"code":"13151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Cmplx Rpr E/n/e/l 2.6-7.5 Cm","code_information":[{"code":"2202516","type":"CDM"},{"code":"360","type":"RC"},{"code":"13152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Repair Complex Area 5 Cm Or Less","code_information":[{"code":"2202518","type":"CDM"},{"code":"360","type":"RC"},{"code":"13153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Cmplx Rpr S/a/l 2.6-7.5 Cm","code_information":[{"code":"2202524","type":"CDM"},{"code":"360","type":"RC"},{"code":"13121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Repair Complex Trunk 1.1 Cm To 2.5 Cm","code_information":[{"code":"2202526","type":"CDM"},{"code":"360","type":"RC"},{"code":"13100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Repair Complex Trunk 2.6 Cm To 7.5 Cm","code_information":[{"code":"2202528","type":"CDM"},{"code":"360","type":"RC"},{"code":"13101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Repair Complex Trunk Each Add <5 Cm","code_information":[{"code":"2202530","type":"CDM"},{"code":"360","type":"RC"},{"code":"13102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Intmd Rpr S/a/t/ext 2.6-7.5 Cm","code_information":[{"code":"2202544","type":"CDM"},{"code":"360","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Rfa Sacroiliac Joint W/ Image Guidance","code_information":[{"code":"2202625","type":"CDM"},{"code":"360","type":"RC"},{"code":"64625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1508,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Sigmoidoscopy W/submuc Inj","code_information":[{"code":"2202657","type":"CDM"},{"code":"360","type":"RC"},{"code":"45335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Rpr F/e/e/n/l/m 2.5 Cm/<","code_information":[{"code":"2202662","type":"CDM"},{"code":"360","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Rpr S/n/ax/gen/trnk 2.5cm/<","code_information":[{"code":"2202664","type":"CDM"},{"code":"360","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Rpr S/n/ax/gen/trnk2.6-7.5cm","code_information":[{"code":"2202666","type":"CDM"},{"code":"360","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Ther Spi Pnxr Csf Fluor/ct","code_information":[{"code":"2202673","type":"CDM"},{"code":"360","type":"RC"},{"code":"62329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Strapping Unna Boot","code_information":[{"code":"2202683","type":"CDM"},{"code":"940","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":300,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Tenodesis At Wrist Extensors Fingers","code_information":[{"code":"2202741","type":"CDM"},{"code":"360","type":"RC"},{"code":"25301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Stereotactic Ca Cranial Extradural","code_information":[{"code":"2202787","type":"CDM"},{"code":"360","type":"RC"},{"code":"61782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Aspirate Pleura W/ Imaging","code_information":[{"code":"2202789","type":"CDM"},{"code":"360","type":"RC"},{"code":"32555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Revision Of Bladder Neck","code_information":[{"code":"2202841","type":"CDM"},{"code":"360","type":"RC"},{"code":"52500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1232,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tap Block Bi Injection","code_information":[{"code":"2202845","type":"CDM"},{"code":"360","type":"RC"},{"code":"64488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tap Block Uni By Infusion","code_information":[{"code":"2202847","type":"CDM"},{"code":"360","type":"RC"},{"code":"64487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Tap Block Bi By Infusion","code_information":[{"code":"2202849","type":"CDM"},{"code":"360","type":"RC"},{"code":"64489","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Care Of Miscarriage","code_information":[{"code":"2202855","type":"CDM"},{"code":"360","type":"RC"},{"code":"59820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1665,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Treatment Of Miscarriage","code_information":[{"code":"2202857","type":"CDM"},{"code":"360","type":"RC"},{"code":"59821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1665,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1665},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Closure Of Split Wound","code_information":[{"code":"2202859","type":"CDM"},{"code":"360","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Under Inj Procedure On The Spine","code_information":[{"code":"2202877","type":"CDM"},{"code":"360","type":"RC"},{"code":"62328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Dental Surgery Procedure","code_information":[{"code":"2202904","type":"CDM"},{"code":"360","type":"RC"},{"code":"41899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Procedure Nervous System","code_information":[{"code":"2202924","type":"CDM"},{"code":"360","type":"RC"},{"code":"64999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Skin Tissue Procedure","code_information":[{"code":"2202932","type":"CDM"},{"code":"360","type":"RC"},{"code":"17999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Egd Us Fine Needle Bx/aspir","code_information":[{"code":"2202949","type":"CDM"},{"code":"360","type":"RC"},{"code":"43238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":1058,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Remove Ventilating Tube","code_information":[{"code":"2202962","type":"CDM"},{"code":"360","type":"RC"},{"code":"69424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":924,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Or Level 1 Add Min","code_information":[{"code":"2202989","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP2202989","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":115,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Pulm Strs Tstg Cplx","code_information":[{"code":"8500376","type":"CDM"},{"code":"94621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":210,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Cast Hand&lower Forearm Gauntlet","code_information":[{"code":"8500238","type":"CDM"},{"code":"29085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":113,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Calculus Qualitative Analysis","code_information":[{"code":"4000083","type":"CDM"},{"code":"300","type":"RC"},{"code":"82355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":113,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Calculus Qualitative Analysis","code_information":[{"code":"8400506","type":"CDM"},{"code":"300","type":"RC"},{"code":"82355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":113,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"App Modality To 1 Or More Area Whirlpool","code_information":[{"code":"6100006","type":"CDM"},{"code":"420","type":"RC"},{"code":"97022","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":113,"maximum":225,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Antibody Rickettsia","code_information":[{"code":"4000044","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":113,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Rickettsia Antibody","code_information":[{"code":"8400684","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":113,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Antibody Bartonella","code_information":[{"code":"4000018","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":113,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Albuterol Sulfate (Albuterol) 5mg/ml","code_information":[{"code":"3000010","type":"CDM"},{"code":"636","type":"RC"},{"code":"48795","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":112,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lipid Intralipid Fat Emulsion 20% 100ml","code_information":[{"code":"3000164","type":"CDM"},{"code":"636","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":112,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Antibody Rubella","code_information":[{"code":"8400686","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":112,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Inj-unlist Thera Proph/dx Iv/ia Njx/nfs","code_information":[{"code":"8500394","type":"CDM"},{"code":"320","type":"RC"},{"code":"96379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":112,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Orl- Readycat/gastrografin","code_information":[{"code":"3060827","type":"CDM"},{"code":"250","type":"RC"},{"code":"27004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":111,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cult Bact W/isolation&presump Idnt Urine","code_information":[{"code":"4000268","type":"CDM"},{"code":"300","type":"RC"},{"code":"87088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":111,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Monohtrophl Antibodies Scr","code_information":[{"code":"8400639","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":111,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Cholesterol Serum/whl Bld Tot","code_information":[{"code":"8400510","type":"CDM"},{"code":"300","type":"RC"},{"code":"82465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":111,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Lovenox 30mg/0.3ml","code_information":[{"code":"3000170","type":"CDM"},{"code":"636","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":111,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Bentyldicyclomine Injection 20mg","code_information":[{"code":"8400867","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":111,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Alligator Forceps","code_information":[{"code":"8401158","type":"CDM"},{"code":"450","type":"RC"},{"code":"99070","type":"CPT","modifier":"ALFOR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ALFOR"],"minimum":110,"maximum":110,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Special Stains List W Frozen Sections","code_information":[{"code":"4000350","type":"CDM"},{"code":"310","type":"RC"},{"code":"88314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":110,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Inf Agent Detection Trichomona Vaginalis","code_information":[{"code":"4000243","type":"CDM"},{"code":"300","type":"RC"},{"code":"87661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":109,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Trichomonas Vaginalis Amplif","code_information":[{"code":"8400773","type":"CDM"},{"code":"300","type":"RC"},{"code":"87661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":109,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Creatinine Other Source","code_information":[{"code":"4000108","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":109,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Antibody West Nile Virus","code_information":[{"code":"4000052","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":108,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"West Nile Virus Antibody","code_information":[{"code":"8400693","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":108,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Arthrocentesis Aspir&/inj Inter Jt/bursa","code_information":[{"code":"8500147","type":"CDM"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":924,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Assay Of Copper","code_information":[{"code":"8400513","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":108,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Synthes Cortx Screws 13mm","code_information":[{"code":"2800742","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Synthes Self Tapping Screw 14mm","code_information":[{"code":"2800744","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Smr Prim Src Spec Stain Bodies/parasits","code_information":[{"code":"8400725","type":"CDM"},{"code":"300","type":"RC"},{"code":"87207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Blood Count Hematocrit Hct","code_information":[{"code":"4000066","type":"CDM"},{"code":"300","type":"RC"},{"code":"85014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Blood Count Hemoglobin Hgb","code_information":[{"code":"4000067","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Blood Smear Peripheral Interpretation","code_information":[{"code":"4000073","type":"CDM"},{"code":"300","type":"RC"},{"code":"85060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Bld# Hematocrit","code_information":[{"code":"8400606","type":"CDM"},{"code":"300","type":"RC"},{"code":"85014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Bld# Hgb","code_information":[{"code":"8400607","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"White Blood Count (Wbc)","code_information":[{"code":"8400613","type":"CDM"},{"code":"300","type":"RC"},{"code":"85048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Blood Smear Interpretation","code_information":[{"code":"8400615","type":"CDM"},{"code":"300","type":"RC"},{"code":"85060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":107,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Magnevist 5ml","code_information":[{"code":"3000178","type":"CDM"},{"code":"636","type":"RC"},{"code":"50149018801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":106,"maximum":106,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Collect Cap Blood Spec Finger/heel/ear","code_information":[{"code":"2200551","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":106,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Collection Venous Blood By Venipuncture","code_information":[{"code":"2200552","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":106,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Venipuncture","code_information":[{"code":"4099995","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":106,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Alcohol Brth","code_information":[{"code":"8400492","type":"CDM"},{"code":"300","type":"RC"},{"code":"82075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":106,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Blood Count Reticulocyte Manual","code_information":[{"code":"4000072","type":"CDM"},{"code":"300","type":"RC"},{"code":"85044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":105,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Bld# Reticulocyte Mnl","code_information":[{"code":"8400611","type":"CDM"},{"code":"300","type":"RC"},{"code":"85044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":105,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Lymphocytotoxicity Assay Visu Crossmatch","code_information":[{"code":"4000296","type":"CDM"},{"code":"300","type":"RC"},{"code":"86806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":105,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Lymphocytotoxicity","code_information":[{"code":"8400698","type":"CDM"},{"code":"300","type":"RC"},{"code":"86806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":105,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Analgesics Nonopioid 5","code_information":[{"code":"4000013","type":"CDM"},{"code":"300","type":"RC"},{"code":"80330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Analgesics Non-opioid 3-5","code_information":[{"code":"8400476","type":"CDM"},{"code":"300","type":"RC"},{"code":"80330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Ativanlorazepam Injection 2mg","code_information":[{"code":"8400922","type":"CDM"},{"code":"450","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Albumin Serum","code_information":[{"code":"4000005","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Wound Cleanser","code_information":[{"code":"8401290","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Inf Agent Cytomegalovirus Direct","code_information":[{"code":"4000212","type":"CDM"},{"code":"300","type":"RC"},{"code":"87271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Inf Agent Antigen Det Rsv","code_information":[{"code":"4000215","type":"CDM"},{"code":"300","type":"RC"},{"code":"87280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Inf Agnt Antigen Chlamydia Trachomatis","code_information":[{"code":"8400730","type":"CDM"},{"code":"300","type":"RC"},{"code":"87270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Inf Agnt Antigen Cytomegalovirus","code_information":[{"code":"8400731","type":"CDM"},{"code":"300","type":"RC"},{"code":"87271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Iaadi Rsv","code_information":[{"code":"8400734","type":"CDM"},{"code":"300","type":"RC"},{"code":"87280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Antibody Cytomegalovirus Cmv Igm","code_information":[{"code":"4000024","type":"CDM"},{"code":"300","type":"RC"},{"code":"86645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Antibody Cytomegalovirus Cmv Igm","code_information":[{"code":"8400660","type":"CDM"},{"code":"300","type":"RC"},{"code":"86645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":104,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Osteopath Manj 1-2 Regions Involved","code_information":[{"code":"8400397","type":"CDM"},{"code":"450","type":"RC"},{"code":"98925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":103,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Iaad Eia Rsv","code_information":[{"code":"8400743","type":"CDM"},{"code":"300","type":"RC"},{"code":"87420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":103,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Rotavirus Ag Eia","code_information":[{"code":"8400744","type":"CDM"},{"code":"300","type":"RC"},{"code":"87425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":103,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Lithium","code_information":[{"code":"4000295","type":"CDM"},{"code":"300","type":"RC"},{"code":"80178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":103,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Antibody Rubeola","code_information":[{"code":"8400687","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":103,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Remove Impacted Ear Wax Uni","code_information":[{"code":"8500346","type":"CDM"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":924,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"2019 Ncovsars Cov Any Tech Non Cdc","code_information":[{"code":"8400800","type":"CDM"},{"code":"450","type":"RC"},{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":103,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Azelastine Nasal Spray 30ml","code_information":[{"code":"3060855","type":"CDM"},{"code":"250","type":"RC"},{"code":"51525029403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Arthrocentesis Aspir&/inj Mjr Jt/ Bursa","code_information":[{"code":"8500150","type":"CDM"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":924,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Hepatitis A Antibody Qualitative","code_information":[{"code":"4000176","type":"CDM"},{"code":"300","type":"RC"},{"code":"86708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Hepatitis B Core Antibody Hbcab Igm Anti","code_information":[{"code":"4000177","type":"CDM"},{"code":"300","type":"RC"},{"code":"86705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Hepatitis B Core Antibody Hbcab Total","code_information":[{"code":"4000178","type":"CDM"},{"code":"300","type":"RC"},{"code":"86704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Thyroglobulin Antibody","code_information":[{"code":"4000360","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Hepatitis B Core Antibody (Hbcab) Total","code_information":[{"code":"8400672","type":"CDM"},{"code":"300","type":"RC"},{"code":"86704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Hep B Core Antibody Igm","code_information":[{"code":"8400673","type":"CDM"},{"code":"300","type":"RC"},{"code":"86705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Thyroglobulin Antibody","code_information":[{"code":"8400695","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Hepatitis C Ab Test","code_information":[{"code":"8400696","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Estrogens Total","code_information":[{"code":"4000141","type":"CDM"},{"code":"300","type":"RC"},{"code":"82672","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Estrogens Total","code_information":[{"code":"8400526","type":"CDM"},{"code":"300","type":"RC"},{"code":"82672","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Acetaminophen","code_information":[{"code":"4000014","type":"CDM"},{"code":"300","type":"RC"},{"code":"80329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":102,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Antibody Helicobacter Pylori","code_information":[{"code":"8400665","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":101,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Clindamycin 300mg Iv/im","code_information":[{"code":"8401133","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"CLIN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CLIN"],"minimum":101,"maximum":101,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Acetone/other Ketone Bodies Serum Quant","code_information":[{"code":"4000002","type":"CDM"},{"code":"300","type":"RC"},{"code":"82010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":101,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Platelet Aggregation","code_information":[{"code":"8400623","type":"CDM"},{"code":"300","type":"RC"},{"code":"85576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":100,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Buprenorphine Oral 1 Mg","code_information":[{"code":"8400869","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":100,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Albuterol/ipratropium 0.5mg And 3mg/3ml","code_information":[{"code":"3000012","type":"CDM"},{"code":"636","type":"RC"},{"code":"48702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":100,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dark Field Exam Any Source","code_information":[{"code":"4000125","type":"CDM"},{"code":"300","type":"RC"},{"code":"87164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":100,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Urine Pregnancy Test","code_information":[{"code":"4000279","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":99,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Urinalysis Microscopic Only","code_information":[{"code":"4000387","type":"CDM"},{"code":"300","type":"RC"},{"code":"81015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":99,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Microscopic Exam Of Urine","code_information":[{"code":"8400483","type":"CDM"},{"code":"300","type":"RC"},{"code":"81015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":99,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Urine Preg Tst Vis Color Cmprsn Meths","code_information":[{"code":"8400484","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":99,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Long Arm Splint Shoulder Hand","code_information":[{"code":"8500239","type":"CDM"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":99,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Glutamyltransferase Gamma Ggt","code_information":[{"code":"4000165","type":"CDM"},{"code":"300","type":"RC"},{"code":"82977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":99,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Blood Count Platelet Automated","code_information":[{"code":"4000069","type":"CDM"},{"code":"300","type":"RC"},{"code":"85049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":99,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Blood Count Platelet Automated","code_information":[{"code":"8400614","type":"CDM"},{"code":"300","type":"RC"},{"code":"85049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":99,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Crystal Id By Light Microscopy","code_information":[{"code":"4000109","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":98,"gross_charge":123,"discounted_cash":123,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Suction Tubing Used W Pump","code_information":[{"code":"8401308","type":"CDM"},{"code":"450","type":"RC"},{"code":"A7002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":98,"gross_charge":123,"discounted_cash":123,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Sedimentation Rate Erythrocyte Automated","code_information":[{"code":"4000336","type":"CDM"},{"code":"300","type":"RC"},{"code":"85652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":98,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Sedimentation Rate Rbc Auto","code_information":[{"code":"8400626","type":"CDM"},{"code":"300","type":"RC"},{"code":"85652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":98,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Drug Test Prsmv Chem Anlyzr","code_information":[{"code":"8400473","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":98,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Cast Sup Lng Arm Fbrg Ped","code_information":[{"code":"8401349","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":98,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Cast Sup Lng Leg Fbrgl Ped","code_information":[{"code":"8401355","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":98,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Walker Folding Adjust/fixed","code_information":[{"code":"8401322","type":"CDM"},{"code":"450","type":"RC"},{"code":"E0135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":97,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Ear Mold/insert","code_information":[{"code":"8400438","type":"CDM"},{"code":"450","type":"RC"},{"code":"V5264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":97,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Ear Mold/insert Disposable Any Type","code_information":[{"code":"8400439","type":"CDM"},{"code":"450","type":"RC"},{"code":"V5265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":97,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Wet Mount","code_information":[{"code":"4000345","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":97,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Smr Prim Src Wet Mount Nfct Agt","code_information":[{"code":"8400726","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":97,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Acumed Guidewire .062  L8699","code_information":[{"code":"2800049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":96,"gross_charge":120,"discounted_cash":120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Agglutinins Febrile Brucella Francisella","code_information":[{"code":"4000004","type":"CDM"},{"code":"300","type":"RC"},{"code":"86000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":96,"gross_charge":120,"discounted_cash":120,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"App Modality =>1 Areas Elec Stim Ea 15 M","code_information":[{"code":"6100001","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":95,"maximum":225,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"App Modality =>1 Areas Elec Stim Ea 15 M","code_information":[{"code":"6100079","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":95,"maximum":225,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"App Modality =>1 Areas Elec Stim Ea 15 M","code_information":[{"code":"6100080","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":95,"maximum":225,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Moderate Sedation Addit 15 Min 5yrs+","code_information":[{"code":"8500409","type":"CDM"},{"code":"99157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":95,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Lactated Ringers 1000ml","code_information":[{"code":"3000138","type":"CDM"},{"code":"258","type":"RC"},{"code":"3380111704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":95,"maximum":95,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ringers Lactate Infusion","code_information":[{"code":"8401029","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":95,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Atropine 5ml Abboject 0.5mg/5ml","code_information":[{"code":"3000026","type":"CDM"},{"code":"636","type":"RC"},{"code":"40949","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":95,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Control Nasal Hemorrhage Anterior Simple","code_information":[{"code":"8500258","type":"CDM"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":924,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Caldolor Ibuprofen 800mg/200ml","code_information":[{"code":"3000040","type":"CDM"},{"code":"636","type":"RC"},{"code":"66220028422","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":94,"maximum":94,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Cast Figure Of 8","code_information":[{"code":"8500237","type":"CDM"},{"code":"29049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":94,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Vitamin B12 Injection","code_information":[{"code":"8400961","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":94,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Haloperidol Injection","code_information":[{"code":"8400900","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Haloperidol Decanoate Inj","code_information":[{"code":"8400901","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Calcium Total","code_information":[{"code":"4000082","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Calcium Tot","code_information":[{"code":"8400504","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Lactate","code_information":[{"code":"8400551","type":"CDM"},{"code":"300","type":"RC"},{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Lactate (Ld) (Ldh) Enzyme","code_information":[{"code":"8400552","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Strapping Knee","code_information":[{"code":"8500250","type":"CDM"},{"code":"29530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Sickling Rbc Reduction","code_information":[{"code":"4000340","type":"CDM"},{"code":"300","type":"RC"},{"code":"85660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Rbc Sickle Cell Test","code_information":[{"code":"8400627","type":"CDM"},{"code":"300","type":"RC"},{"code":"85660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":93,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Pulmonary Stress Test","code_information":[{"code":"8500375","type":"CDM"},{"code":"94620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":1060,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1060}]}]},{"description":"Assay Carbamazepine Total","code_information":[{"code":"8400458","type":"CDM"},{"code":"450","type":"RC"},{"code":"80156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Assay Of Digoxin","code_information":[{"code":"8400459","type":"CDM"},{"code":"450","type":"RC"},{"code":"80162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Assay Of Phenytoin Total","code_information":[{"code":"8400466","type":"CDM"},{"code":"300","type":"RC"},{"code":"80185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Immunization Admin Inj Vaccine/toxoid","code_information":[{"code":"1000141","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Cmv Antibody","code_information":[{"code":"8400659","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Protein Electrop Fxj&quan Oth Flus Conen","code_information":[{"code":"8400576","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Spectinomycn Di-hcl Inj","code_information":[{"code":"8400956","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Wrist Cock-up Non-molded","code_information":[{"code":"8401341","type":"CDM"},{"code":"450","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Cast Sup Shrt Leg Fiberglass Adult","code_information":[{"code":"8401353","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Short Arm Splint Forearm-hand Static","code_information":[{"code":"8500240","type":"CDM"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Short Arm Splint Dynamic","code_information":[{"code":"8500241","type":"CDM"},{"code":"29126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Finger Splint Static","code_information":[{"code":"8500242","type":"CDM"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":300,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Long Leg Splint Thigh Ankle/toes","code_information":[{"code":"8500247","type":"CDM"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Short Leg Splint Calf Foot","code_information":[{"code":"8500248","type":"CDM"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":300,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Strapping Toes","code_information":[{"code":"8500252","type":"CDM"},{"code":"29550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Antibody Rotavirus","code_information":[{"code":"8400685","type":"CDM"},{"code":"300","type":"RC"},{"code":"86759","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Cath Set Cricothyrotomy Melker","code_information":[{"code":"8401232","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CRIC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CRIC"],"minimum":92,"maximum":92,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Scopolamine Patch Transderm","code_information":[{"code":"3000259","type":"CDM"},{"code":"636","type":"RC"},{"code":"10019055304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":91,"maximum":91,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bld Typing Rh D","code_information":[{"code":"8400702","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Blood Typing Patient Serum","code_information":[{"code":"8400703","type":"CDM"},{"code":"300","type":"RC"},{"code":"86904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Blood Typing Rbc Antigens","code_information":[{"code":"8400704","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Bld Typing Rh Phexyping Compl","code_information":[{"code":"8400705","type":"CDM"},{"code":"300","type":"RC"},{"code":"86906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Procainamide Hcl Injection","code_information":[{"code":"8400939","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"G6pc Gene","code_information":[{"code":"8400485","type":"CDM"},{"code":"300","type":"RC"},{"code":"81250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Cath Inf Insert Periph Central Midline","code_information":[{"code":"8401317","type":"CDM"},{"code":"450","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Phenothiazine","code_information":[{"code":"4000314","type":"CDM"},{"code":"300","type":"RC"},{"code":"84022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Assay Of Phenothiazine","code_information":[{"code":"8400563","type":"CDM"},{"code":"300","type":"RC"},{"code":"84022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"4000384","type":"CDM"},{"code":"301","type":"RC"},{"code":"81001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"8400480","type":"CDM"},{"code":"301","type":"RC"},{"code":"81001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":90,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Naso/oro-gas Tube Plmt Req Phys&fluor Gd","code_information":[{"code":"8500292","type":"CDM"},{"code":"43752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":1058,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1058},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Verapamil 2.5mg/ml 2ml Vial","code_information":[{"code":"3000312","type":"CDM"},{"code":"636","type":"RC"},{"code":"40911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":89,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Smear Prim Source With Interpret Fluoro","code_information":[{"code":"4000342","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":89,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Gi Cocktail","code_information":[{"code":"3000109","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alcohols","code_information":[{"code":"4000007","type":"CDM"},{"code":"300","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Drugs Or Substances Definitive Qualitat","code_information":[{"code":"4000135","type":"CDM"},{"code":"300","type":"RC"},{"code":"80375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Drug Screen Quantalcohols","code_information":[{"code":"8400474","type":"CDM"},{"code":"300","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Analgesics Non-opioid 1 Or 2","code_information":[{"code":"8400475","type":"CDM"},{"code":"300","type":"RC"},{"code":"80329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Drug/substance Def Qual/quantitative","code_information":[{"code":"8400478","type":"CDM"},{"code":"300","type":"RC"},{"code":"80375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Barbiturates","code_information":[{"code":"4000058","type":"CDM"},{"code":"300","type":"RC"},{"code":"80345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Drug Screening Barbiturates","code_information":[{"code":"8400477","type":"CDM"},{"code":"300","type":"RC"},{"code":"80345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Splint Digit","code_information":[{"code":"8401366","type":"CDM"},{"code":"450","type":"RC"},{"code":"S8450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Prolactin","code_information":[{"code":"8400571","type":"CDM"},{"code":"300","type":"RC"},{"code":"84146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":88,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"N Block Inj Plantar Digit","code_information":[{"code":"8500329","type":"CDM"},{"code":"64455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":924,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Rhythm Ecg One To Three Leads Interpreta","code_information":[{"code":"4200016","type":"CDM"},{"code":"730","type":"RC"},{"code":"93042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Rhythm Ecg 1-3 Lds I&r Only","code_information":[{"code":"8400365","type":"CDM"},{"code":"450","type":"RC"},{"code":"93042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Avulsion Nail Plate Prtl Cmp Ea Addtl","code_information":[{"code":"8500089","type":"CDM"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":924,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Epinephrine 0.1mg/ml Abboject Syr 10ml","code_information":[{"code":"3000087","type":"CDM"},{"code":"636","type":"RC"},{"code":"76329331601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":86,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Morphine Sulf 150mg/30ml (5mg/ml) Pca","code_information":[{"code":"3060750","type":"CDM"},{"code":"258","type":"RC"},{"code":"61553065774","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":86,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Neo-synephrine Phenylephrine Hcl Inj","code_information":[{"code":"8400932","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":86,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Neo-synephrine Phenylephrine Hcl Inj","code_information":[{"code":"8444231","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":86,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Rheumatoid Factor Quantitative","code_information":[{"code":"4000334","type":"CDM"},{"code":"300","type":"RC"},{"code":"86431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":86,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Rheumatoid Factor Quantitative","code_information":[{"code":"8400648","type":"CDM"},{"code":"300","type":"RC"},{"code":"86431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":86,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Zithromax Azithromycin For Inj 500mg","code_information":[{"code":"8400865","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":85,"gross_charge":106,"discounted_cash":106,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Imm Admin Subq Or Im One Vaccine","code_information":[{"code":"8400351","type":"CDM"},{"code":"450","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":85,"gross_charge":106,"discounted_cash":106,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Opthalmic/ Eye Burr","code_information":[{"code":"8401220","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"BURR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BURR"],"minimum":84,"maximum":84,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Pressurized/nonpressurized Inhalation Tx","code_information":[{"code":"8500377","type":"CDM"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":210,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Hepb Adult Dose3 Dose Schedule Im Use","code_information":[{"code":"8400838","type":"CDM"},{"code":"250","type":"RC"},{"code":"90746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":83,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inhalation Treatmentcontinuous 1st Hr","code_information":[{"code":"8500378","type":"CDM"},{"code":"94644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":210,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Blood Occult By Fecal Hgb","code_information":[{"code":"4000077","type":"CDM"},{"code":"300","type":"RC"},{"code":"82274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Bld Oclt Fecal Hgb Deter Ia Qual Fcs 1-3","code_information":[{"code":"8400502","type":"CDM"},{"code":"300","type":"RC"},{"code":"82274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Laryngoscopy Indirect Diagnostic Spx","code_information":[{"code":"8500263","type":"CDM"},{"code":"31505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Pacu Each Add'l Min","code_information":[{"code":"2000001","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP2000001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Midtown Pacu Each Add'l Min","code_information":[{"code":"2000003","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP2000003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Gonadotropin Follicle Stim Hormone (Fsh)","code_information":[{"code":"8400541","type":"CDM"},{"code":"300","type":"RC"},{"code":"83001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Bilirubin Total","code_information":[{"code":"4000062","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Bilirubin Tot","code_information":[{"code":"8400497","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Skin Test Tuberculosis Intradermal","code_information":[{"code":"4000341","type":"CDM"},{"code":"300","type":"RC"},{"code":"86580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":82,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Carbon Dioxide Bicarbonate","code_information":[{"code":"4000085","type":"CDM"},{"code":"300","type":"RC"},{"code":"82374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":81,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Assay Of Calcium","code_information":[{"code":"8400505","type":"CDM"},{"code":"300","type":"RC"},{"code":"82330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":81,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Carbon Dioxide","code_information":[{"code":"8400507","type":"CDM"},{"code":"300","type":"RC"},{"code":"82374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":81,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Carcinoembryonic Antigen","code_information":[{"code":"8400508","type":"CDM"},{"code":"300","type":"RC"},{"code":"82378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":81,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Glucose Blood Reagent Strip","code_information":[{"code":"4000162","type":"CDM"},{"code":"300","type":"RC"},{"code":"82948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":81,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Gluc Bld Rgnt Strip","code_information":[{"code":"8400537","type":"CDM"},{"code":"300","type":"RC"},{"code":"82948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":81,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Ggtglutamyltrase Gamma","code_information":[{"code":"8400540","type":"CDM"},{"code":"300","type":"RC"},{"code":"82977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":81,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Cast Short Arm Splint Ped","code_information":[{"code":"8401352","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":81,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Herpes Simplex Type 1 Test","code_information":[{"code":"8400668","type":"CDM"},{"code":"300","type":"RC"},{"code":"86695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Herpes Simplex Type 2 Test","code_information":[{"code":"8400669","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Cast Sup Short Arm Fiberglass Peds","code_information":[{"code":"8401347","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Blood Count Blood Smear Microscopic Exam","code_information":[{"code":"4000064","type":"CDM"},{"code":"305","type":"RC"},{"code":"85007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Carbon Monoxide Carboxyhemoglobin Quanti","code_information":[{"code":"4000086","type":"CDM"},{"code":"300","type":"RC"},{"code":"82375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Inf Agent Ant Herpes Simplex Virus Type2","code_information":[{"code":"4000213","type":"CDM"},{"code":"300","type":"RC"},{"code":"87274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Inf Agent Ant Herpes Simplex Virus Type3","code_information":[{"code":"4000214","type":"CDM"},{"code":"300","type":"RC"},{"code":"87273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Herpes Simplex 2 Ag","code_information":[{"code":"8400732","type":"CDM"},{"code":"300","type":"RC"},{"code":"87273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Herpes Simplex 1 Ag","code_information":[{"code":"8400733","type":"CDM"},{"code":"300","type":"RC"},{"code":"87274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Hypertonic Saline Solution","code_information":[{"code":"8401030","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":80,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Inf Agent Antigen Hiv1 And Hiv2 Antibodi","code_information":[{"code":"4000209","type":"CDM"},{"code":"300","type":"RC"},{"code":"87806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":79,"gross_charge":99,"discounted_cash":99,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Hiv Antigen W/hiv Antibodies","code_information":[{"code":"8400779","type":"CDM"},{"code":"300","type":"RC"},{"code":"87806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":79,"gross_charge":99,"discounted_cash":99,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Piperacillin/tazobact (Zosyn) 3.375gm Vl","code_information":[{"code":"3000240","type":"CDM"},{"code":"636","type":"RC"},{"code":"78131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":79,"gross_charge":99,"discounted_cash":99,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Inj Peniclln G Potassium 600 000 Units/<","code_information":[{"code":"8400935","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":79,"gross_charge":99,"discounted_cash":99,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Toxoplasma Antibody","code_information":[{"code":"8400689","type":"CDM"},{"code":"300","type":"RC"},{"code":"86777","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":79,"gross_charge":99,"discounted_cash":99,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Mod Sed Same Phys/qhp Ea","code_information":[{"code":"8500407","type":"CDM"},{"code":"99153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":79,"gross_charge":99,"discounted_cash":99,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Removal/revision Of Cast","code_information":[{"code":"8500255","type":"CDM"},{"code":"29705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":79,"gross_charge":99,"discounted_cash":99,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Ertapenem Injection","code_information":[{"code":"8400896","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":78,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Readi-cat Barium 24x450ml Berry","code_information":[{"code":"3000257","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909072503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":78,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":450,"type":"ML"}},{"description":"Electrodes Pair","code_information":[{"code":"8401203","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":78,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Rheumatoid Factor Qualitative","code_information":[{"code":"4000333","type":"CDM"},{"code":"300","type":"RC"},{"code":"86430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":78,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Flow Cytometry Cell Each Add Marker","code_information":[{"code":"4000147","type":"CDM"},{"code":"310","type":"RC"},{"code":"88185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":78,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Diflucan 200mg/100ml","code_information":[{"code":"3000075","type":"CDM"},{"code":"250","type":"RC"},{"code":"33860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":78,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Dicyclomine (Bentyl) 20mg/2ml Inj","code_information":[{"code":"3060837","type":"CDM"},{"code":"250","type":"RC"},{"code":"51719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":78,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rheumatoid Factor Qual","code_information":[{"code":"8400647","type":"CDM"},{"code":"300","type":"RC"},{"code":"86430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":78,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Cyanocobalamin","code_information":[{"code":"8400522","type":"CDM"},{"code":"300","type":"RC"},{"code":"82607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":77,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Inf Agent Det Dna Or Rna Enterovirus","code_information":[{"code":"4000226","type":"CDM"},{"code":"300","type":"RC"},{"code":"87498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":77,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Enterovirus Detection","code_information":[{"code":"8400754","type":"CDM"},{"code":"300","type":"RC"},{"code":"87498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":77,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"App Modality =>One Areas Paraffin Bath","code_information":[{"code":"6100003","type":"CDM"},{"code":"420","type":"RC"},{"code":"97018","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":77,"maximum":225,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Collect Blood From Implant Ven Acc Dvc","code_information":[{"code":"8500278","type":"CDM"},{"code":"36591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":300,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300}]}]},{"description":"Rhythm Ecg 1-3 Lds Trcg Only W/o I&r","code_information":[{"code":"8500364","type":"CDM"},{"code":"93041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Tte Rt W/image Doc 2d Inc M-mode Record","code_information":[{"code":"8500368","type":"CDM"},{"code":"93308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Neo/poly/dex 3.5gm Opth Ointment","code_information":[{"code":"3060864","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":76,"maximum":76,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":35,"type":"GR"}},{"description":"Debridement/high Press Waterjet W/wo Sct","code_information":[{"code":"8500396","type":"CDM"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":924,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Triamcinolone Pf 40mg/ml 2ml Vial","code_information":[{"code":"3000304","type":"CDM"},{"code":"636","type":"RC"},{"code":"12420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":76,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Cell Count  With Differential Count","code_information":[{"code":"4000258","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":76,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"Acell Burn Matrix 7 X10 Cm Per Sqcm","code_information":[{"code":"2800022","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":75,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Synthes 4.0mm Cancellous Bone Screw Full","code_information":[{"code":"2800616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":75,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Hespan 6% 500ml","code_information":[{"code":"3000117","type":"CDM"},{"code":"636","type":"RC"},{"code":"26419","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Famotidine 10mg/ml 2ml Vial","code_information":[{"code":"3000094","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sodium Serum","code_information":[{"code":"4000346","type":"CDM"},{"code":"300","type":"RC"},{"code":"84295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Chloride Bld","code_information":[{"code":"8400509","type":"CDM"},{"code":"300","type":"RC"},{"code":"82435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Sodium Serum Plasma Or Whole Blood","code_information":[{"code":"8400578","type":"CDM"},{"code":"300","type":"RC"},{"code":"84295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Pepcid- Injection Famotidine 20 Mg","code_information":[{"code":"8400985","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pepcidinjection Famotidine 20 Mg","code_information":[{"code":"8401117","type":"CDM"},{"code":"450","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Succinylcholine 20mg/ml 10ml","code_information":[{"code":"3000288","type":"CDM"},{"code":"636","type":"RC"},{"code":"40966","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Influenza Virus Vaccine Live Intranasal","code_information":[{"code":"8400822","type":"CDM"},{"code":"250","type":"RC"},{"code":"90660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"D5w Infusion","code_information":[{"code":"8401027","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Ipecac/similar Adm Emesis&obs Stmch Empt","code_information":[{"code":"8500412","type":"CDM"},{"code":"99175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":74,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Gastrografin 66-10% 24x30ml","code_information":[{"code":"3000105","type":"CDM"},{"code":"636","type":"RC"},{"code":"27004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":73,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Gelfoam 7mm","code_information":[{"code":"3000106","type":"CDM"},{"code":"636","type":"RC"},{"code":"90342","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":73,"maximum":73,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Suture Plain Gut 5-0 Pc-1","code_information":[{"code":"8401260","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU2"],"minimum":73,"maximum":73,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73}]}]},{"description":"Suture Chromic Gut 5-0 Ps-5","code_information":[{"code":"8401267","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU8"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU8"],"minimum":73,"maximum":73,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73}]}]},{"description":"Gluc Bld Mntr Dev Cleared Fda Spec Home","code_information":[{"code":"8400539","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":72,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Inj Trigger Points 3/> Sng/mult Tendon","code_information":[{"code":"8500145","type":"CDM"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":924,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Total Cortisol","code_information":[{"code":"8400514","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":72,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Hurricane Spray","code_information":[{"code":"8401086","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":72,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Creatine","code_information":[{"code":"4000103","type":"CDM"},{"code":"300","type":"RC"},{"code":"82540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":72,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Creatine","code_information":[{"code":"8400515","type":"CDM"},{"code":"300","type":"RC"},{"code":"82540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":72,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Debride Exten Eczematous/infected Skin","code_information":[{"code":"8500076","type":"CDM"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":924,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Phosphatase Alkaline","code_information":[{"code":"4000317","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":71,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Injection Tendon Origin/insertion","code_information":[{"code":"8500143","type":"CDM"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":924,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Ct Injector Kit","code_information":[{"code":"8401161","type":"CDM"},{"code":"270","type":"RC"},{"code":"99070","type":"CPT","modifier":"CTINJ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CTINJ"],"minimum":70,"maximum":70,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Under Qualitat/semiquantitative Immnassy","code_information":[{"code":"8400697","type":"CDM"},{"code":"300","type":"RC"},{"code":"86804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":70,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Bilirubin Direct","code_information":[{"code":"4000061","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":69,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Gonadotropin Luteinizing Hormone (Lh)","code_information":[{"code":"8400542","type":"CDM"},{"code":"300","type":"RC"},{"code":"83002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":69,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Ria Nonantibody","code_information":[{"code":"8400546","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":69,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Benadryl 50mg/ml","code_information":[{"code":"3000031","type":"CDM"},{"code":"636","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":69,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nicardipine 2.5mg/ml 10ml Vial","code_information":[{"code":"3000217","type":"CDM"},{"code":"636","type":"RC"},{"code":"14396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":69,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metro 2.5 Kwire","code_information":[{"code":"2800765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":68,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Susceptibility Study Antimicrobial Agent","code_information":[{"code":"4000352","type":"CDM"},{"code":"300","type":"RC"},{"code":"87181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":68,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Ova&parasits Dir Smrs Concentration&id","code_information":[{"code":"8400722","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":68,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Suscept Stud Antimicrobial Agnt Agar Dil","code_information":[{"code":"8400723","type":"CDM"},{"code":"300","type":"RC"},{"code":"87181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":68,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Sex Hormone Binding Globulin Shbg","code_information":[{"code":"4000339","type":"CDM"},{"code":"300","type":"RC"},{"code":"84270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":68,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Sex Hormone Binding Globulin (Shbg)","code_information":[{"code":"8400577","type":"CDM"},{"code":"300","type":"RC"},{"code":"84270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":68,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Dark Field Examination","code_information":[{"code":"8400721","type":"CDM"},{"code":"300","type":"RC"},{"code":"87164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":68,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Assay Of Folic Acid Rbc","code_information":[{"code":"8400530","type":"CDM"},{"code":"300","type":"RC"},{"code":"82747","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":68,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Hemoglobin Glycosylated (A1c)","code_information":[{"code":"8400544","type":"CDM"},{"code":"300","type":"RC"},{"code":"83036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":67,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Urinalysis","code_information":[{"code":"4000278","type":"CDM"},{"code":"300","type":"RC"},{"code":"81005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":67,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Removal Of Sutures","code_information":[{"code":"8500435","type":"CDM"},{"code":"S0630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":67,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Nitroglycerin Paste 1 Strip","code_information":[{"code":"8401003","type":"CDM"},{"code":"636","type":"RC"},{"code":"28103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":1232,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Potassium Chloride Per 2 Meq Iv","code_information":[{"code":"8400964","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":67,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Removal/bivalving Gauntlet Boot/body Cst","code_information":[{"code":"8500254","type":"CDM"},{"code":"29700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Antib Herpes Simplex Nonspecific Type","code_information":[{"code":"4000030","type":"CDM"},{"code":"300","type":"RC"},{"code":"86694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Antb Herpes Smplx Non-spec Typ Tst","code_information":[{"code":"8400667","type":"CDM"},{"code":"300","type":"RC"},{"code":"86694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Inf Agent Det Dna/rna Trichomo Vaginalis","code_information":[{"code":"4000244","type":"CDM"},{"code":"300","type":"RC"},{"code":"87660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Gardnerella Vaginalis Direct Probe Tech","code_information":[{"code":"8400758","type":"CDM"},{"code":"300","type":"RC"},{"code":"87510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Trichomonas Vaginalis Direct Probe Tech","code_information":[{"code":"8400772","type":"CDM"},{"code":"300","type":"RC"},{"code":"87660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Electrolyte Golytely Gavilyte 4000ml","code_information":[{"code":"3000083","type":"CDM"},{"code":"636","type":"RC"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":66,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":4000,"type":"ML"}},{"description":"Magnesium Sulfate 50% 10ml Ansyr","code_information":[{"code":"3000176","type":"CDM"},{"code":"636","type":"RC"},{"code":"40917","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Allergen Specific Ige Quantitative","code_information":[{"code":"4000009","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Papaverine 30mg/ml 2ml Vial","code_information":[{"code":"3000233","type":"CDM"},{"code":"636","type":"RC"},{"code":"51740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Stool Cultr Aerobic Bact Ea","code_information":[{"code":"8400709","type":"CDM"},{"code":"300","type":"RC"},{"code":"87046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":66,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Injection Tendon Sheath/ligament","code_information":[{"code":"8500142","type":"CDM"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":924,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Assay Toxin Or Antitoxin","code_information":[{"code":"8400727","type":"CDM"},{"code":"300","type":"RC"},{"code":"87230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":65,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Imm Admin 18 Yr/< Of Age","code_information":[{"code":"8500350","type":"CDM"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":65,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Omnipaque 240 10ml","code_information":[{"code":"3000224","type":"CDM"},{"code":"636","type":"RC"},{"code":"40714","type":"CPT","modifier":"191"}],"standard_charges":[{"setting":"outpatient","modifier_code":["191"],"minimum":65,"maximum":65,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Antb Virus Nes","code_information":[{"code":"8400694","type":"CDM"},{"code":"300","type":"RC"},{"code":"86790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":64,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Chlorpromazine Hcl Injection","code_information":[{"code":"8400953","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":64,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Infrared Light Therapy","code_information":[{"code":"6100041","type":"CDM"},{"code":"424","type":"RC"},{"code":"97026","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":63,"maximum":225,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Infrared Light Therapy","code_information":[{"code":"6100042","type":"CDM"},{"code":"424","type":"RC"},{"code":"97026","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":63,"maximum":225,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Inj Single/mlt Trigger Point 1/2 Muscles","code_information":[{"code":"8500144","type":"CDM"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":924,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Levofloxacin/ Levaquin 500mg Tablet","code_information":[{"code":"8401071","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":63,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levofloxacin/ Levaquin 500mg Tab Po","code_information":[{"code":"8401143","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"LEVO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LEVO"],"minimum":63,"maximum":63,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Methocarbomal Injection","code_information":[{"code":"8400946","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Iv Tubing Extension Set","code_information":[{"code":"8401360","type":"CDM"},{"code":"450","type":"RC"},{"code":"S1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Nf-bystolic Oral Tablet 20mg","code_information":[{"code":"3061043","type":"CDM"},{"code":"250","type":"RC"},{"code":"55154462208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":62,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Phytonadione 10mg/ml (Vitamin K)","code_information":[{"code":"3000239","type":"CDM"},{"code":"636","type":"RC"},{"code":"40991","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Levetiracetam","code_information":[{"code":"4000291","type":"CDM"},{"code":"300","type":"RC"},{"code":"80177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Drug Scrn Quan Levetiracetam","code_information":[{"code":"8400463","type":"CDM"},{"code":"300","type":"RC"},{"code":"80177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Lithium","code_information":[{"code":"8400464","type":"CDM"},{"code":"300","type":"RC"},{"code":"80178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Osteopath Manj 1-2 Regions Involved","code_information":[{"code":"8500397","type":"CDM"},{"code":"98925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Dextrose 50% 25g/50ml : 50ml","code_information":[{"code":"3000072","type":"CDM"},{"code":"258","type":"RC"},{"code":"40975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Adenosine 3mg/ml","code_information":[{"code":"3000007","type":"CDM"},{"code":"636","type":"RC"},{"code":"17478054202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Adenosine Inj 1mg","code_information":[{"code":"8400858","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Crutch Underarm Pair No Wood","code_information":[{"code":"1000293","type":"CDM"},{"code":"450","type":"RC"},{"code":"E0114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Zosynpiperacillin/tazobactam","code_information":[{"code":"8400936","type":"CDM"},{"code":"636","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Crutch Underarm Pair No Wood","code_information":[{"code":"8401319","type":"CDM"},{"code":"290","type":"RC"},{"code":"E0114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Crutch Underarm Each No Wood","code_information":[{"code":"8401320","type":"CDM"},{"code":"450","type":"RC"},{"code":"E0116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Masknebulizer Maskspacer With Mask","code_information":[{"code":"8401363","type":"CDM"},{"code":"450","type":"RC"},{"code":"S8101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":62,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Estradiol","code_information":[{"code":"8400525","type":"CDM"},{"code":"300","type":"RC"},{"code":"82670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":61,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Dextrose 50% 50ml","code_information":[{"code":"8400980","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":61,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Sodium Bicarbonate 8.4% 50ml 1meq/ml","code_information":[{"code":"8401016","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":61,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Fluzone Vacc 3 Yrs & > Im","code_information":[{"code":"8401108","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":61,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Antibody Mycoplasma","code_information":[{"code":"4000039","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":61,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Syphilis Test Quantitative","code_information":[{"code":"4000354","type":"CDM"},{"code":"300","type":"RC"},{"code":"86593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":61,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Bldr Irrigation Smpl Lvg&/instlj","code_information":[{"code":"8500302","type":"CDM"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":924,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Tee R-t Img 2d W/probe Plmt Only","code_information":[{"code":"8500369","type":"CDM"},{"code":"93313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Inhalation Treatmenteach Addt`l Hr","code_information":[{"code":"8500379","type":"CDM"},{"code":"94645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":210,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210}]}]},{"description":"Antinuclear Antibodies Ana Titer","code_information":[{"code":"4000056","type":"CDM"},{"code":"300","type":"RC"},{"code":"86039","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":60,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Agglutinins Febrile Ea Ag","code_information":[{"code":"8400629","type":"CDM"},{"code":"300","type":"RC"},{"code":"86000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":60,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Antinuclear Antibodies (Ana)","code_information":[{"code":"8400632","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":60,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Ana Titer","code_information":[{"code":"8400633","type":"CDM"},{"code":"300","type":"RC"},{"code":"86039","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":60,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Nf-spironolactone Oral Tablet 50mg","code_information":[{"code":"3060887","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746021701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":60,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Synovial Fluid Crystals","code_information":[{"code":"8400792","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":60,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Antib Borrelia Burgdorferi Lyme Dis Conf","code_information":[{"code":"4000020","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":59,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"Lyme Disease Antibody","code_information":[{"code":"8400655","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":59,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"Phenol Carbolic Acid 10ml","code_information":[{"code":"3000234","type":"CDM"},{"code":"636","type":"RC"},{"code":"7191916007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":59,"maximum":59,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Decalcification Pro List","code_information":[{"code":"4000126","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":59,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"Arthrocentesis Aspir&/inj Inter Jt/bursa","code_information":[{"code":"8500146","type":"CDM"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":924,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"Nebulizer Administration Set","code_information":[{"code":"8401309","type":"CDM"},{"code":"450","type":"RC"},{"code":"A7003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":59,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"Transferrin","code_information":[{"code":"8400588","type":"CDM"},{"code":"300","type":"RC"},{"code":"84466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":59,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"Smear Gram Stain","code_information":[{"code":"4000343","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":58,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Syphilis Test Qualitative Eg Vdrl Rpr Ar","code_information":[{"code":"4000353","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":58,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Coagulation Time Activated","code_information":[{"code":"4000093","type":"CDM"},{"code":"300","type":"RC"},{"code":"85347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":58,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Epinephrine 1mg/ml Amp","code_information":[{"code":"3000089","type":"CDM"},{"code":"636","type":"RC"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":58,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nimbex 2mg/ml","code_information":[{"code":"3000219","type":"CDM"},{"code":"636","type":"RC"},{"code":"74438","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":58,"maximum":58,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Gamma Globulin 1 Cc Inj","code_information":[{"code":"8400897","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":58,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Morphine Pf 1mg/ml Amp","code_information":[{"code":"3000207","type":"CDM"},{"code":"636","type":"RC"},{"code":"40938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":57,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"One Way Chest Drain Valve","code_information":[{"code":"8401311","type":"CDM"},{"code":"450","type":"RC"},{"code":"A7040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":57,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Metoprolol Tartrate Vl 1mg/ml Iv","code_information":[{"code":"8400999","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":57,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Culture Anaerobe Ident Each","code_information":[{"code":"8400713","type":"CDM"},{"code":"300","type":"RC"},{"code":"87076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":56,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Cul Bact Aerobic Isolate","code_information":[{"code":"8400714","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":56,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Inj Tc-99m Sestamibi","code_information":[{"code":"5000162","type":"CDM"},{"code":"340","type":"RC"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":56,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Amoxicillin Clavulanate/ Tab 875-125mg","code_information":[{"code":"8401051","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":56,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Augmentin/amoxicillin Clav Tab 875-125mg","code_information":[{"code":"8401130","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"AUG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AUG"],"minimum":56,"maximum":56,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Sodium Chloride 0.9% 1000 Ml","code_information":[{"code":"3000271","type":"CDM"},{"code":"258","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":56,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Normal Saline Solution Infus 1000cc","code_information":[{"code":"8401022","type":"CDM"},{"code":"258","type":"RC"},{"code":"26478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":924,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Oxygen Saturation Results Doc & Review","code_information":[{"code":"8400256","type":"CDM"},{"code":"450","type":"RC"},{"code":"3028F","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":55,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Spacer Without Mask","code_information":[{"code":"8401362","type":"CDM"},{"code":"450","type":"RC"},{"code":"S8100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":55,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Electrocardiogram, routine, with interpretation and report","code_information":[{"code":"8500360","type":"CDM"},{"code":"730","type":"RC"},{"code":"93000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Ecg Rout Ecg W/lst 12 Lds Trcg W/o I&r","code_information":[{"code":"8500361","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Ecg Routine Ecg W/least 12 Lds I&r Ekg","code_information":[{"code":"8500362","type":"CDM"},{"code":"93010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Rhythm Ecg 1-3 Lds W/i&r","code_information":[{"code":"8500363","type":"CDM"},{"code":"93040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Compression Bandage","code_information":[{"code":"8401365","type":"CDM"},{"code":"450","type":"RC"},{"code":"S8431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":54,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Suture Prolene 6-0 P-3","code_information":[{"code":"8401253","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU13"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU13"],"minimum":54,"maximum":54,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Lidocaine Viscous 2% 100 Ml Bottle","code_information":[{"code":"3000161","type":"CDM"},{"code":"636","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":54,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Viscous Xylocaine","code_information":[{"code":"8400992","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":54,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine Viscous","code_information":[{"code":"8401127","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5000","type":"HCPCS","modifier":"LIDO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LIDO"],"minimum":54,"maximum":54,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Methylprednisolone Acet 80mg/ml 1ml Vial","code_information":[{"code":"3000193","type":"CDM"},{"code":"636","type":"RC"},{"code":"93475","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":53,"maximum":53,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Garamycin Gentamicin Inj","code_information":[{"code":"8400898","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":53,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Inj Nalbuphine Hydrochloride","code_information":[{"code":"8400927","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":53,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Naloxone 0.4mg/ml","code_information":[{"code":"3000211","type":"CDM"},{"code":"636","type":"RC"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":53,"maximum":53,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Under Therapeutic Drug Assays","code_information":[{"code":"8400470","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":53,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Allergen Specific Ige","code_information":[{"code":"8400631","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":53,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Chrom Quan Column 1 Anal Nes","code_information":[{"code":"8400511","type":"CDM"},{"code":"300","type":"RC"},{"code":"82491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":52,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Allergen Specific Igg Quantitative","code_information":[{"code":"4000010","type":"CDM"},{"code":"300","type":"RC"},{"code":"86001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":52,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Allergen Specific Igg","code_information":[{"code":"8400630","type":"CDM"},{"code":"300","type":"RC"},{"code":"86001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":52,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Sensorcaine With Epi 0.25% 50ml","code_information":[{"code":"3000263","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":51,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Digoxin Free","code_information":[{"code":"4000128","type":"CDM"},{"code":"450","type":"RC"},{"code":"80163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":51,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Assay Of Digoxin Free","code_information":[{"code":"8400460","type":"CDM"},{"code":"450","type":"RC"},{"code":"80163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":51,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Anesthesia Each Add'l Min","code_information":[{"code":"2600006","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP2600006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":51,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Midtown Anesthesia Each Add'l Min","code_information":[{"code":"2600008","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP2600008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":51,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Inj Tc-99m Choletec","code_information":[{"code":"5000160","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":51,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Total Protein","code_information":[{"code":"4000330","type":"CDM"},{"code":"300","type":"RC"},{"code":"84155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":50,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Suture Prolene 4-0 Ps-2","code_information":[{"code":"8401251","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU11"],"minimum":50,"maximum":50,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Injection Phytonadione Vitamin K Per 1mg","code_information":[{"code":"8400962","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":50,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Blood Count Red Blood Cell Rbc Automated","code_information":[{"code":"4000070","type":"CDM"},{"code":"300","type":"RC"},{"code":"85041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":50,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Injection Bupivicaine Hydro","code_information":[{"code":"8401116","type":"CDM"},{"code":"450","type":"RC"},{"code":"S0020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":49,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Surgical Shoe/boot Each","code_information":[{"code":"8401336","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":49,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Return Check Fee","code_information":[{"code":"8400444","type":"CDM"},{"code":"450","type":"RC"},{"code":"99999","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":49,"maximum":49,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Marcaine 0.25% 10ml","code_information":[{"code":"3000180","type":"CDM"},{"code":"636","type":"RC"},{"code":"40911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":49,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Debridement Of Nail(s) By Any Method 1-5","code_information":[{"code":"8500087","type":"CDM"},{"code":"11720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":924,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Cefepime (Maxipime) 1gm Vl","code_information":[{"code":"3000046","type":"CDM"},{"code":"636","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":49,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime Hcl For Injection","code_information":[{"code":"8400874","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":49,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Cefoxitin Sodium Injection","code_information":[{"code":"8400875","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":49,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Suture Vicryl 5-0 P-3","code_information":[{"code":"8401257","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU17"],"minimum":48,"maximum":48,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Olympus Armstrong Grommet Tube","code_information":[{"code":"2800337","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":48,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Meas Pst-vd Res Urine &/Or Bladdr Cap Us","code_information":[{"code":"8500306","type":"CDM"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":48,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Qnhp Ol Dig Assmt&mgmt 5-10","code_information":[{"code":"6100065","type":"CDM"},{"code":"424","type":"RC"},{"code":"98970","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":47,"maximum":225,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Qnhp Ol Dig Assmt&mgmt 5-10","code_information":[{"code":"6100066","type":"CDM"},{"code":"424","type":"RC"},{"code":"98970","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":47,"maximum":225,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Metoclopramide Hcl Injection","code_information":[{"code":"8400942","type":"CDM"},{"code":"450","type":"RC"},{"code":"40934","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":47,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Flagyl 500mg Po","code_information":[{"code":"8401139","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"FLA"}],"standard_charges":[{"setting":"outpatient","modifier_code":["FLA"],"minimum":47,"maximum":47,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Iv Pump Tubing-check Valve W/3 Smar","code_information":[{"code":"8401277","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"TU3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TU3"],"minimum":47,"maximum":47,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Iv Tub Interlink Set Buretrol 150ml 120","code_information":[{"code":"8500807","type":"CDM"},{"code":"A4649","type":"HCPCS","modifier":"TU"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TU"],"minimum":47,"maximum":47,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Iv Tubing Secondary 15 Drp 40","code_information":[{"code":"8500808","type":"CDM"},{"code":"A4649","type":"HCPCS","modifier":"TU2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TU2"],"minimum":47,"maximum":47,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Inj Naloxone Hydrochloride","code_information":[{"code":"8400928","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":46,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Suture Ethlon 6-0 P-1","code_information":[{"code":"8401263","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU4"],"minimum":46,"maximum":46,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Suture Ethlon 5-0 P-3","code_information":[{"code":"8401264","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU5"],"minimum":46,"maximum":46,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Amiodarone 50mg/ml 3ml","code_information":[{"code":"3000016","type":"CDM"},{"code":"636","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":46,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ampicillin 1gm Vial","code_information":[{"code":"3000019","type":"CDM"},{"code":"636","type":"RC"},{"code":"78194","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":46,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Drug Test Read By Intstrument","code_information":[{"code":"4000134","type":"CDM"},{"code":"300","type":"RC"},{"code":"80306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":45,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Drug Test Prsmv Instrmnt","code_information":[{"code":"8400472","type":"CDM"},{"code":"300","type":"RC"},{"code":"80306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":45,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Anoscopy Inc Collection Of Specimen","code_information":[{"code":"8500300","type":"CDM"},{"code":"46600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":924,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Rapid Imm Qualit Rsp Syncytial Virus Ant","code_information":[{"code":"8400780","type":"CDM"},{"code":"300","type":"RC"},{"code":"87807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":44,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Monsels 8ml Topical Soln","code_information":[{"code":"3000205","type":"CDM"},{"code":"636","type":"RC"},{"code":"48783011208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":44,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Under Therapeutic Drug Assays","code_information":[{"code":"8400465","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":44,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Influenza Virus Vaccine","code_information":[{"code":"3000126","type":"CDM"},{"code":"636","type":"RC"},{"code":"80835","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":44,"maximum":44,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lovenox 80mg/0.8ml","code_information":[{"code":"3000172","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323053108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":43,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Nitro Stat- Nitroglycerin","code_information":[{"code":"8401004","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":43,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tubular Dressing","code_information":[{"code":"8401305","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":43,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Phenytoin 50mg/ml 2ml Vial","code_information":[{"code":"3000236","type":"CDM"},{"code":"636","type":"RC"},{"code":"64104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":43,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Capillary Blood Draw","code_information":[{"code":"8400275","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":43,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Handlg&/or Convey Spec For Tr Pt To Lab","code_information":[{"code":"8400399","type":"CDM"},{"code":"450","type":"RC"},{"code":"99001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":43,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Phenytoin Sodium Injection","code_information":[{"code":"8400888","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":43,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Dilaudid Hydromorphone Up To 4mg","code_information":[{"code":"8400889","type":"CDM"},{"code":"450","type":"RC"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":43,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nicardipine/sdv 2.5mg","code_information":[{"code":"8401002","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":42,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Imm Admin Ea Addtl Vaccine/toxoid","code_information":[{"code":"8400352","type":"CDM"},{"code":"450","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":195,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Enoxaparin 60mg/0.6ml","code_information":[{"code":"3000086","type":"CDM"},{"code":"636","type":"RC"},{"code":"60505079300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":42,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Silver Nitrate Sticks Each","code_information":[{"code":"8401240","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"NIT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["NIT"],"minimum":42,"maximum":42,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Suture Vicryl 4-0 P-3","code_information":[{"code":"8401258","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU18"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU18"],"minimum":42,"maximum":42,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Suture Vicryl 3-0 Ps-1","code_information":[{"code":"8401261","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU20"],"minimum":42,"maximum":42,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Suture Vicryl 6-0 P-3","code_information":[{"code":"8401269","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SUTUR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SUTUR"],"minimum":42,"maximum":42,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Culture Bct Isol&prsmptv Id Iso Ea Urine","code_information":[{"code":"8400717","type":"CDM"},{"code":"300","type":"RC"},{"code":"87088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":42,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Imm Admin Subq Or Im One Vaccine","code_information":[{"code":"8500351","type":"CDM"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":50,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}]},{"description":"Cast Sup Shrt Leg Splint Ped 10yr/<plstr","code_information":[{"code":"8401357","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q4047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":42,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Drug Test Prsmv Dir Opt Obs","code_information":[{"code":"8400471","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":42,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Injection Sulfamethoxazole","code_information":[{"code":"8401119","type":"CDM"},{"code":"450","type":"RC"},{"code":"S0039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":42,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Omnipaque 350mg/ml 100ml","code_information":[{"code":"3000226","type":"CDM"},{"code":"636","type":"RC"},{"code":"40714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":41,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Omnipaque 300 100ml","code_information":[{"code":"3000225","type":"CDM"},{"code":"636","type":"RC"},{"code":"40714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":41,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Cautery Micro-temp Fine Tip/bovie","code_information":[{"code":"8401159","type":"CDM"},{"code":"450","type":"RC"},{"code":"99070","type":"CPT","modifier":"CAUT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CAUT"],"minimum":41,"maximum":41,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Suture Prolene 5-0 Ps-3","code_information":[{"code":"8401250","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU10"],"minimum":41,"maximum":41,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Suture Prolene 3-0 Fs-1","code_information":[{"code":"8401252","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU12"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU12"],"minimum":41,"maximum":41,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Suture Ethlon 3-0 Ps-1","code_information":[{"code":"8401256","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU16"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU16"],"minimum":41,"maximum":41,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Suture Ethlon 4-0 P-3","code_information":[{"code":"8401265","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU6"],"minimum":41,"maximum":41,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Insulin For Insulin Pump Use","code_information":[{"code":"8400914","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Skn Tst Tuberculosis Id","code_information":[{"code":"8400651","type":"CDM"},{"code":"300","type":"RC"},{"code":"86580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Saliva Test Hormone Lvl During Menopause","code_information":[{"code":"8400798","type":"CDM"},{"code":"450","type":"RC"},{"code":"S3650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Coagulation & Fibrinolysis Functional","code_information":[{"code":"4000092","type":"CDM"},{"code":"300","type":"RC"},{"code":"85397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Hematology And Coagulation Procedures","code_information":[{"code":"8400622","type":"CDM"},{"code":"300","type":"RC"},{"code":"85397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Ipratropium Bromide Comp","code_information":[{"code":"8401047","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Staples","code_information":[{"code":"8401248","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"STAP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["STAP"],"minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Betadine 5% Sterile Ophal Sol 1oz","code_information":[{"code":"3060860","type":"CDM"},{"code":"250","type":"RC"},{"code":"65041","type":"CPT","modifier":"130"}],"standard_charges":[{"setting":"outpatient","modifier_code":["130"],"minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Concentration Infectious Agents","code_information":[{"code":"8400706","type":"CDM"},{"code":"300","type":"RC"},{"code":"87015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":40,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Inj Propofol 10 Mg","code_information":[{"code":"8400934","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":39,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Gentamicin Sulf Opth 0.3% Sol  5ml Btl","code_information":[{"code":"3060865","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":39,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Tamiflu/capsule","code_information":[{"code":"8401088","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":39,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tamiflu Capsule","code_information":[{"code":"8401151","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"TAMI"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TAMI"],"minimum":39,"maximum":39,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Bladder Irrigation Tubing","code_information":[{"code":"8401195","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":39,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Apresoline 20mg/ml","code_information":[{"code":"3000021","type":"CDM"},{"code":"250","type":"RC"},{"code":"83262","type":"CPT","modifier":"605"}],"standard_charges":[{"setting":"outpatient","modifier_code":["605"],"minimum":38,"maximum":38,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"C Reactive Protein High Sensitivity","code_information":[{"code":"8400635","type":"CDM"},{"code":"300","type":"RC"},{"code":"86141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Complement Total Hemolytic Ch50","code_information":[{"code":"8400636","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"App A Modality To=>1 Areas Hot/cold Pack","code_information":[{"code":"6100002","type":"CDM"},{"code":"420","type":"RC"},{"code":"97010","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":38,"maximum":225,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":225}]}]},{"description":"Cell Count Miscellaneous Body Fluids","code_information":[{"code":"4000088","type":"CDM"},{"code":"300","type":"RC"},{"code":"89050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Body Fluid Cell Count","code_information":[{"code":"8400789","type":"CDM"},{"code":"300","type":"RC"},{"code":"89050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Cell Count Misc Body Fluid Except Blood","code_information":[{"code":"8400790","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Dicyclomine 20 Mg Tab","code_information":[{"code":"8401061","type":"CDM"},{"code":"636","type":"RC"},{"code":"60687038001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":38,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Dicyclomine / Bentyl 20mg Tablet","code_information":[{"code":"8401137","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"DICY"}],"standard_charges":[{"setting":"outpatient","modifier_code":["DICY"],"minimum":38,"maximum":38,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Test For Acetoneketones","code_information":[{"code":"8400489","type":"CDM"},{"code":"300","type":"RC"},{"code":"82009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Acetone/oth Ketone Bodies Serum Quan","code_information":[{"code":"8400490","type":"CDM"},{"code":"300","type":"RC"},{"code":"82010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Tetracaine Opthalmic Drops","code_information":[{"code":"8401017","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tobramycin Sulfate Injection","code_information":[{"code":"8400954","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Inj Propofol 10 Mg","code_information":[{"code":"8400940","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Lyrica 75mg Cap","code_information":[{"code":"3000174","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"441"}],"standard_charges":[{"setting":"outpatient","modifier_code":["441"],"minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Bile Acids Total","code_information":[{"code":"4000060","type":"CDM"},{"code":"300","type":"RC"},{"code":"82239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Bile Acids Total","code_information":[{"code":"8400496","type":"CDM"},{"code":"300","type":"RC"},{"code":"82239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Insta-char Sorbitol","code_information":[{"code":"8401069","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inj Dobutamine Hydrochloride Per 250 Mg","code_information":[{"code":"8400894","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":38,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Coagj Tm Activated","code_information":[{"code":"8400616","type":"CDM"},{"code":"300","type":"RC"},{"code":"85347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":37,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Mineral Oil","code_information":[{"code":"3000202","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":37,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Syphilis Test Non Treponemal Ab Qual","code_information":[{"code":"8400652","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":37,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Cdc 2019 Novel Coronavirus Rt Pcr Panel","code_information":[{"code":"8400799","type":"CDM"},{"code":"450","type":"RC"},{"code":"U0001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":37,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"5+ Cc Sterile Syringe&needle","code_information":[{"code":"8401169","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":37,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Geodonziprasidone Mesylate 10mg","code_information":[{"code":"8400965","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":37,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Lamotrigine","code_information":[{"code":"4000282","type":"CDM"},{"code":"300","type":"RC"},{"code":"80175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":36,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Lamotrigine","code_information":[{"code":"8400462","type":"CDM"},{"code":"300","type":"RC"},{"code":"80175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":36,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Alkaloids Not Otherwise Specified","code_information":[{"code":"4000008","type":"CDM"},{"code":"300","type":"RC"},{"code":"80323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":36,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Skin Seal Protect Moisturizer Ointment","code_information":[{"code":"8401288","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":36,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Ehrlichia","code_information":[{"code":"8400664","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":36,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Protozoa","code_information":[{"code":"8400682","type":"CDM"},{"code":"300","type":"RC"},{"code":"86753","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":36,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Sodium Bicarbonate 8.4% 50ml","code_information":[{"code":"3000269","type":"CDM"},{"code":"636","type":"RC"},{"code":"40966","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":36,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Phosphatase Alkaline","code_information":[{"code":"8400564","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":36,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Solu-cortef 100mg/2ml 2ml Vial","code_information":[{"code":"3000281","type":"CDM"},{"code":"636","type":"RC"},{"code":"90825","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Inj Tc-99m Mdp","code_information":[{"code":"5000161","type":"CDM"},{"code":"340","type":"RC"},{"code":"A9503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Vision Supply Accessory &/Or Svc Comp","code_information":[{"code":"8401370","type":"CDM"},{"code":"450","type":"RC"},{"code":"V2797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Misc Vision Item Or Service","code_information":[{"code":"8401371","type":"CDM"},{"code":"450","type":"RC"},{"code":"V2799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Lidocaine Hcl 2% 20mg/ml 5ml Abboject","code_information":[{"code":"3000158","type":"CDM"},{"code":"636","type":"RC"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Adhesive Liquid Or Equal Any Type Per Oz","code_information":[{"code":"8401197","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Dermabondwound Closure By Adhesive","code_information":[{"code":"8401325","type":"CDM"},{"code":"450","type":"RC"},{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Wound Closure Utilizing Tissue Adhesive(","code_information":[{"code":"10000286","type":"CDM"},{"code":"450","type":"RC"},{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Glycopyrrolate 0.2mg/ml 1ml","code_information":[{"code":"3000111","type":"CDM"},{"code":"636","type":"RC"},{"code":"70069001125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":35,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Mupirocin 2% 22gm Cream","code_information":[{"code":"3000210","type":"CDM"},{"code":"636","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":34,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":22,"type":"GR"}},{"description":"Antivertdimenhydrinate Injection 50mg","code_information":[{"code":"8400893","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Albumin Serum Plasma/whole Blood","code_information":[{"code":"8400491","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Nf-pantoprazole Sodium Iv Pwd For Soln 4","code_information":[{"code":"3061014","type":"CDM"},{"code":"250","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lovenox 40mg/0.4ml","code_information":[{"code":"3000171","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323053508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lovenoxinj Enoxaparin Sodium 10mg","code_information":[{"code":"8400905","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Acetazolamid Sodium Inj Up To 500mg","code_information":[{"code":"8400886","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Benadryl Diphenhydramine Hcl Inj 50mg","code_information":[{"code":"3061740","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Benadryl Diphenhydramine Hcl Inj 50mg","code_information":[{"code":"8400891","type":"CDM"},{"code":"636","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Labetalol Hcl 5mg/ml Iv","code_information":[{"code":"8400991","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Silvadene Cream 1% 20gm","code_information":[{"code":"8401015","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":20,"type":"GR"}},{"description":"Labetalol Hcl 5mg/ml Iv","code_information":[{"code":"8401141","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"LAB"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LAB"],"minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Cleocin 150 Mg/ml","code_information":[{"code":"8400979","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Cleocinclindamycin Phosp 300mg","code_information":[{"code":"8401120","type":"CDM"},{"code":"450","type":"RC"},{"code":"S0077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Cleocinclindamycin Phosp 300mg","code_information":[{"code":"8409102","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cath Indw Foley 3 Way","code_information":[{"code":"8401192","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Cefoxitin (Mefoxin) 1gm Vl","code_information":[{"code":"3000185","type":"CDM"},{"code":"636","type":"RC"},{"code":"25021010910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":34,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Solu-medrol Pf 125mg 2ml Vial","code_information":[{"code":"3000282","type":"CDM"},{"code":"636","type":"RC"},{"code":"90047","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":33,"maximum":33,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Digoxin 500mcg/2ml","code_information":[{"code":"3000076","type":"CDM"},{"code":"636","type":"RC"},{"code":"64114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":33,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lidocaine 2 % 20 Ml Vial","code_information":[{"code":"3000152","type":"CDM"},{"code":"636","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":33,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Insulin Injection","code_information":[{"code":"8400913","type":"CDM"},{"code":"250","type":"RC"},{"code":"30002821517","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine Hci For Iv Infusion 10mg","code_information":[{"code":"8400921","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Enema Supp Antiemetic Rectal/supp Nos","code_information":[{"code":"8401049","type":"CDM"},{"code":"450","type":"RC"},{"code":"J8498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Ampicillin Sodium Per 1.5 Gmunasyn","code_information":[{"code":"8400862","type":"CDM"},{"code":"450","type":"RC"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Lidocaine 1% 100mg/5ml 5ml Abboject","code_information":[{"code":"3000145","type":"CDM"},{"code":"636","type":"RC"},{"code":"40920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Naropin 0.75% 7.5mg 20ml","code_information":[{"code":"3000214","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323028523","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Tranexamic Acid 100mg/ml 10ml","code_information":[{"code":"3000302","type":"CDM"},{"code":"636","type":"RC"},{"code":"23155016641","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ipratropium Bro (Atrovent) Inh Sol 2.5ml","code_information":[{"code":"3000129","type":"CDM"},{"code":"636","type":"RC"},{"code":"48798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Atrovent 0.5 Ipratropium Bromide Noncomp","code_information":[{"code":"8401046","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":32,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ear Curette/wire Loop","code_information":[{"code":"8401162","type":"CDM"},{"code":"270","type":"RC"},{"code":"99070","type":"CPT","modifier":"EAR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EAR"],"minimum":31,"maximum":31,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Magnesium Sulf Ivpb: 4gm/100ml","code_information":[{"code":"3060869","type":"CDM"},{"code":"258","type":"RC"},{"code":"40967","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":31,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Smear Prim Src W/intrprt Gram/giemsa Stn","code_information":[{"code":"8400724","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Leukocyte Assessment","code_information":[{"code":"8400791","type":"CDM"},{"code":"300","type":"RC"},{"code":"89055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Syphilis Test Non-treponemal Ab Quant","code_information":[{"code":"8400653","type":"CDM"},{"code":"300","type":"RC"},{"code":"86593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Activated Charcoal 25g","code_information":[{"code":"8400977","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Activated Charcoal 25 G","code_information":[{"code":"8401131","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"CHAR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CHAR"],"minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Als Esophageal Intub Suppls","code_information":[{"code":"8401167","type":"CDM"},{"code":"270","type":"RC"},{"code":"A0396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Rx Ketamine 100mg/ml Nd","code_information":[{"code":"2800366","type":"CDM"},{"code":"278","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Protein Xcpt Refract Serum Plasm/whl Bld","code_information":[{"code":"8400574","type":"CDM"},{"code":"300","type":"RC"},{"code":"84155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Ciprofloxacin Ophtalmic 0.3% 2.5ml","code_information":[{"code":"8400978","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Surgicel","code_information":[{"code":"8401198","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4364","type":"HCPCS","modifier":"SURG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SURG"],"minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Iodoform Packing Strips/gz Non-impreg","code_information":[{"code":"8401293","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Insert Try Wo/drn Bg W/indwll Cath Foley","code_information":[{"code":"8401182","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Clonidine 0.1mg Patch","code_information":[{"code":"3000059","type":"CDM"},{"code":"636","type":"RC"},{"code":"37808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Guaifeneisin (Mucinex) 600mg Tab","code_information":[{"code":"3060861","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824000832","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Propranolol 1mg/ml 1ml Vial","code_information":[{"code":"3000254","type":"CDM"},{"code":"636","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyclopentolate Hcl Drop Ophth 1mg","code_information":[{"code":"8400984","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Biogl Oph/tst Stp 1mg/cyclpnt Hcl Drp Op","code_information":[{"code":"8401064","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dopamine 400mg/250ml In 5% Dextrose","code_information":[{"code":"3000081","type":"CDM"},{"code":"636","type":"RC"},{"code":"40978","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":30,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Chlorhexadrine 4% 4 Oz","code_information":[{"code":"3000055","type":"CDM"},{"code":"250","type":"RC"},{"code":"51432052122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":30,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naropin 0.2% 2mg/ml 10ml Vial","code_information":[{"code":"3000212","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323028523","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":29,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Norco 5/325 Mg","code_information":[{"code":"8401005","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":29,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Norco 5/325 Mg","code_information":[{"code":"8401080","type":"CDM"},{"code":"636","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":29,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Norco 5/325mg","code_information":[{"code":"8401147","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"NOR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["NOR"],"minimum":29,"maximum":29,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Candida Species Direct Probe Technique","code_information":[{"code":"8400748","type":"CDM"},{"code":"300","type":"RC"},{"code":"87480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":29,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Meperidine Hydrochl /100 Mg","code_information":[{"code":"8400924","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":29,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Meperidine 50mg/ml","code_information":[{"code":"3000187","type":"CDM"},{"code":"636","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":29,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lacerationsurgical Kit","code_information":[{"code":"8401202","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":29,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Specimen Collection Covid","code_information":[{"code":"8400797","type":"CDM"},{"code":"450","type":"RC"},{"code":"G2024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Ca 125","code_information":[{"code":"8400638","type":"CDM"},{"code":"300","type":"RC"},{"code":"86304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Venipuncture","code_information":[{"code":"8400274","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Dexamethasone Comp Con","code_information":[{"code":"8401043","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexamethasone Comp Unit","code_information":[{"code":"8401044","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Meclizine 25mg Po","code_information":[{"code":"3000184","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162044210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bupivacaine/ 0.5% 50ml","code_information":[{"code":"8400973","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Formoteral Inh Soln Cmpd. Ud","code_information":[{"code":"8401045","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inj Prohance 20ml","code_information":[{"code":"3061172","type":"CDM"},{"code":"636","type":"RC"},{"code":"27011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Normal Saline Sol Infus 500 Ml=1 Unit","code_information":[{"code":"8401023","type":"CDM"},{"code":"250","type":"RC"},{"code":"26478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":924,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"5 Dextrose Normal Saline","code_information":[{"code":"8401024","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Sterile Water/saline 500 Ml","code_information":[{"code":"8401173","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Blood Count Reticulocyte Automated","code_information":[{"code":"4000071","type":"CDM"},{"code":"300","type":"RC"},{"code":"85045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Blood Count Reticulocyte Automated","code_information":[{"code":"8400612","type":"CDM"},{"code":"300","type":"RC"},{"code":"85045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"5% Dextrose/water","code_information":[{"code":"8401026","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Insulin Rapid 5 U","code_information":[{"code":"8401157","type":"CDM"},{"code":"250","type":"RC"},{"code":"S5550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cardiac Monitoring /Telemetry","code_information":[{"code":"8500402","type":"CDM"},{"code":"99070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":28,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Genmethimazole 5 Mg","code_information":[{"code":"3061737","type":"CDM"},{"code":"636","type":"RC"},{"code":"23155007001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxygen Saturation Results Doc & Review","code_information":[{"code":"8500256","type":"CDM"},{"code":"3028F","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Infuvite Vl Adlt Infusion 10ml","code_information":[{"code":"8400989","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Normal Saline Solution Infus 250cc","code_information":[{"code":"8401025","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Erythromycin Eye Ointment 3.5g","code_information":[{"code":"8400982","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":35,"type":"GR"}},{"description":"Lidocaine 4% Topical Solution","code_information":[{"code":"8400996","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Plavix / Clopidogrel/tab 75mg","code_information":[{"code":"8401057","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cyclobenzaprine/flexeril 10mg Tab","code_information":[{"code":"8401058","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diazepam Tab Ud 10mg","code_information":[{"code":"8401060","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clclobenzaprine/flexeril 10mg","code_information":[{"code":"8401135","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"CYCL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CYCL"],"minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Sterile Saline -5% Dextrose&0.45% Saline","code_information":[{"code":"8401155","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Formoterol Comp Unit","code_information":[{"code":"8401031","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Thiamine 200mg/2ml","code_information":[{"code":"3000298","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":27,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Specimen Collection (Covid)","code_information":[{"code":"8400796","type":"CDM"},{"code":"450","type":"RC"},{"code":"G2023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Mannitol Injection","code_information":[{"code":"8400923","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Tourniquet","code_information":[{"code":"8401276","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"TOUR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TOUR"],"minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Alprazolam 0.5mg Tab","code_information":[{"code":"3000014","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884011174","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Betadine/phisohex Solution","code_information":[{"code":"8401177","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Betadine/iodine Swabs/wipes","code_information":[{"code":"8401178","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Magnesium Citrate 1 Bottle","code_information":[{"code":"8400997","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enteral Ng Tubing W/ Stylet","code_information":[{"code":"8401315","type":"CDM"},{"code":"450","type":"RC"},{"code":"B4081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Ciprofloxacin Hcl/tab 500mg","code_information":[{"code":"8401054","type":"CDM"},{"code":"636","type":"RC"},{"code":"90470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ciprofloxacin Hcl/ Tab 500mg","code_information":[{"code":"8401132","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"CIP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CIP"],"minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Norepinephrine 1mg/ml","code_information":[{"code":"3000221","type":"CDM"},{"code":"636","type":"RC"},{"code":"78137","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Magnesium Sulfate Inj Per 500mg","code_information":[{"code":"8400963","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Methylprednisolone Acet 40mg/ml 1ml Vial","code_information":[{"code":"3000192","type":"CDM"},{"code":"636","type":"RC"},{"code":"93073","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":26,"maximum":26,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Dextrose 5% 250ml","code_information":[{"code":"3000070","type":"CDM"},{"code":"258","type":"RC"},{"code":"55154288508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":26,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Inj Pantoprazole Sodium Via","code_information":[{"code":"8400854","type":"CDM"},{"code":"450","type":"RC"},{"code":"C9113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":26,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Etomidate 2mg/ml 10ml Vial","code_information":[{"code":"3000091","type":"CDM"},{"code":"636","type":"RC"},{"code":"55150022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":26,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Acetaminophen Suppository 650mg","code_information":[{"code":"3000005","type":"CDM"},{"code":"636","type":"RC"},{"code":"45802073030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":26,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Sterile Water Irrigation 3000ml Bag","code_information":[{"code":"3000286","type":"CDM"},{"code":"258","type":"RC"},{"code":"99079","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":25,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Doxycycline Mono/cap 100mg","code_information":[{"code":"8401138","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"DOXY"}],"standard_charges":[{"setting":"outpatient","modifier_code":["DOXY"],"minimum":25,"maximum":25,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Potassium Cl 2meq/ml 5ml","code_information":[{"code":"3000244","type":"CDM"},{"code":"636","type":"RC"},{"code":"40966","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":25,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Bilirubin Direct","code_information":[{"code":"8400498","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":25,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Sterile Mineral Oil 100ml","code_information":[{"code":"3060790","type":"CDM"},{"code":"250","type":"RC"},{"code":"51552083605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":25,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Intermittent Urinary Cath","code_information":[{"code":"8401194","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":25,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Lidocaine Hcl","code_information":[{"code":"8401072","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":24,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Catheterfoley 2 Way Silicn","code_information":[{"code":"8401191","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":24,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Lidocaine 2%","code_information":[{"code":"8400993","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":24,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aerosol Mask Used With Dme Nebulizer","code_information":[{"code":"8401310","type":"CDM"},{"code":"450","type":"RC"},{"code":"A7015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":24,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Magnesium Sulfate 50% 500mg/ml Vial","code_information":[{"code":"3000177","type":"CDM"},{"code":"636","type":"RC"},{"code":"40967","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":24,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"C-reactive Protein","code_information":[{"code":"8400634","type":"CDM"},{"code":"300","type":"RC"},{"code":"86140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":23,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Rhythm Ecg 1-3 Lds I&r Only","code_information":[{"code":"8500365","type":"CDM"},{"code":"93042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":275,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":275}]}]},{"description":"Omnipaque 350mg/ml 50ml","code_information":[{"code":"3060859","type":"CDM"},{"code":"636","type":"RC"},{"code":"40714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":23,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Valiumdiazepam Injection Up To 5 Mg","code_information":[{"code":"8400957","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":23,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Valium-diazepam Up To 5 Mg","code_information":[{"code":"8401136","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"DIAZ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["DIAZ"],"minimum":23,"maximum":23,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Naropin 0.5% 5mg/ml 30ml Vial","code_information":[{"code":"3000213","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323028623","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phenergan Promethazine Hcl Inj 50mg/<","code_information":[{"code":"3061738","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Ampicillin 500 Mg Inj","code_information":[{"code":"8400861","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Decadron Dexamethasone Acetate 1mg","code_information":[{"code":"8400884","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1094","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Droperidol/fentanyl Inj","code_information":[{"code":"8400912","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Toradol Ketorolac Tromethamine Per 15mg","code_information":[{"code":"8400915","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lasixfurosemide Injection","code_information":[{"code":"8400917","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zofran (Ondansetron Hcl Injection 1mg)","code_information":[{"code":"8400933","type":"CDM"},{"code":"636","type":"RC"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Phenergan Promethazine Hcl Inj 50mg/<","code_information":[{"code":"8400937","type":"CDM"},{"code":"636","type":"RC"},{"code":"64109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pralidoxine Chloride","code_information":[{"code":"8400941","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Hydroxyzine Hcl Injection","code_information":[{"code":"8400959","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Prochlorperazine Maleate 5mg","code_information":[{"code":"8401102","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q0164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Dexamethasone Sodium Phos 4mg/ml","code_information":[{"code":"3000065","type":"CDM"},{"code":"636","type":"RC"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ketorolac 30mg/ml 1ml Vial","code_information":[{"code":"3000135","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Morphine Sulfate 10mg/ml","code_information":[{"code":"3000208","type":"CDM"},{"code":"636","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Promethazine 25mg/ml","code_information":[{"code":"3000250","type":"CDM"},{"code":"636","type":"RC"},{"code":"64109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Propofol 50mg/50ml","code_information":[{"code":"3000253","type":"CDM"},{"code":"636","type":"RC"},{"code":"6332326957","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Occlusive Eye Patch","code_information":[{"code":"8401295","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Bartonella Antibody","code_information":[{"code":"8400654","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Cefazolin Sodium (Ancef) 1gm Vl","code_information":[{"code":"3000045","type":"CDM"},{"code":"636","type":"RC"},{"code":"14399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ancefcefazolin Sodium Injection 500mg","code_information":[{"code":"8400873","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Heparin 30,000 U/ 30 Ml","code_information":[{"code":"3000114","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Hocm 300-349mg/ml Iodine 1ml","code_information":[{"code":"8401110","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q9962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Hocm 350-399mg/ml Iodine 1ml","code_information":[{"code":"8401111","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q9963","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Locm 100-199mg/ml Iodine 1ml","code_information":[{"code":"8401112","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q9965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Locm 200-299mg/ml Iodine 1ml","code_information":[{"code":"8401113","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q9966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Midazolam 10mg/5ml Syrup","code_information":[{"code":"3000201","type":"CDM"},{"code":"636","type":"RC"},{"code":"54356","type":"CPT","modifier":"699"}],"standard_charges":[{"setting":"outpatient","modifier_code":["699"],"minimum":22,"maximum":22,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluticasone (Flonase) Nasal Spray","code_information":[{"code":"3060857","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383070016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Indwelling Catheter Latex","code_information":[{"code":"8401190","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Magnesium Sulf","code_information":[{"code":"8401073","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levetiracetam Oral Liq 100mg/ml","code_information":[{"code":"3000141","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474000148","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Marcaine 0.25% 50ml","code_information":[{"code":"3000181","type":"CDM"},{"code":"636","type":"RC"},{"code":"40911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":22,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Silvadene 1% 25gm Cream","code_information":[{"code":"3000264","type":"CDM"},{"code":"636","type":"RC"},{"code":"61570013125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Robitussin Oral Liq 100mg/5ml  118ml Btl","code_information":[{"code":"3060847","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000029901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":22,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dicyclomine Hcl (Bentyl) 10mg Cap","code_information":[{"code":"3060836","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687036901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":21,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lactated Ringers 500ml","code_information":[{"code":"3000139","type":"CDM"},{"code":"258","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":21,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Imm Admin Ea Addtl Vaccine/toxoid","code_information":[{"code":"8500352","type":"CDM"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":195,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}]},{"description":"Tetracaine Hydrochloride Solution 0.5%","code_information":[{"code":"3000297","type":"CDM"},{"code":"636","type":"RC"},{"code":"65074","type":"CPT","modifier":"114"}],"standard_charges":[{"setting":"outpatient","modifier_code":["114"],"minimum":21,"maximum":21,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sodium Chloride 0.9% 500ml Inj","code_information":[{"code":"3000280","type":"CDM"},{"code":"636","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":21,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Dextrose 5% 1000ml","code_information":[{"code":"3000069","type":"CDM"},{"code":"636","type":"RC"},{"code":"26476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":924,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Sodium Chloride 500ml Irrigation Bottle","code_information":[{"code":"3000277","type":"CDM"},{"code":"636","type":"RC"},{"code":"40961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":21,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Chloraseptic Spray 20ml","code_information":[{"code":"3000053","type":"CDM"},{"code":"250","type":"RC"},{"code":"78112069480","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":21,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Blood Occult Peroxidase Act Qualitative","code_information":[{"code":"8400500","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":21,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Unclassified Drugs","code_information":[{"code":"8401326","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clindamycin 150mg/ml 2ml Vial","code_information":[{"code":"3000057","type":"CDM"},{"code":"636","type":"RC"},{"code":"25021011504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Insert Try W/drn Bg W/indwll Cath Foley","code_information":[{"code":"8401183","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Prohance Per Ml","code_information":[{"code":"3100013","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inj Heparin Sodium Per 1000u","code_information":[{"code":"8400903","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Tamsulosin /Flomax Cap 0.5-0.4mg","code_information":[{"code":"8401089","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin /Flomax Cap 0.5-0.4mg","code_information":[{"code":"8401152","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"TAMS"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TAMS"],"minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Diabetic Tussin Liq 100mg/5ml  118ml Btl","code_information":[{"code":"3060846","type":"CDM"},{"code":"250","type":"RC"},{"code":"61787006304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Potassium Chl Ivpb: 20meq/100ml","code_information":[{"code":"3060868","type":"CDM"},{"code":"258","type":"RC"},{"code":"99070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ondansetron 4mg/2ml 2ml Vial","code_information":[{"code":"3000227","type":"CDM"},{"code":"636","type":"RC"},{"code":"55154445305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"D5w/sodium Chl 0.45% 1000ml Iv","code_information":[{"code":"3060871","type":"CDM"},{"code":"258","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Diazepam Tab Ud 5mg","code_information":[{"code":"8401059","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Suture Silk 0 Sh","code_information":[{"code":"8401266","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU7"],"minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Calcium Chloride 100 Mg/ml Syringe Ansy","code_information":[{"code":"3000038","type":"CDM"},{"code":"636","type":"RC"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Levalbuterol Comp Con","code_information":[{"code":"8401034","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Xopenexlevalbuterol Non-comp Unit","code_information":[{"code":"8401040","type":"CDM"},{"code":"636","type":"RC"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levalbuterol Comp Unit","code_information":[{"code":"8401041","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcium Chloride/100mg/ml 10ml","code_information":[{"code":"8400974","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ibuprofen (Motrin) Liq 100mg/5ml","code_information":[{"code":"3000052","type":"CDM"},{"code":"250","type":"RC"},{"code":"90453","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sodium Chloride 0.45% 1000ml","code_information":[{"code":"3000270","type":"CDM"},{"code":"636","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Solu-medrol Pf 40mg/ml 1ml Vial","code_information":[{"code":"3000283","type":"CDM"},{"code":"636","type":"RC"},{"code":"90039","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":20,"maximum":20,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Protein Tot Xcpt Refractometry Oth Src","code_information":[{"code":"8400575","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Lactulose","code_information":[{"code":"8401070","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lactulose","code_information":[{"code":"8401142","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"LACT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LACT"],"minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Meropenem (Merrem) 1gm Vial Pwdr","code_information":[{"code":"3060780","type":"CDM"},{"code":"636","type":"RC"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Compazineprochlorperazine 10mg","code_information":[{"code":"8400880","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Syringe With Needle Sterile 1 Cc/less Ea","code_information":[{"code":"8401168","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Potassium Chloride 40meq/20ml","code_information":[{"code":"3000242","type":"CDM"},{"code":"636","type":"RC"},{"code":"40966","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Dexamethasone Pf 10mg/ml","code_information":[{"code":"3000066","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Adrenalin Epinephrine Inject","code_information":[{"code":"8400859","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Metoprolol 1 Mg/ml 5ml","code_information":[{"code":"3000196","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611074010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Metoprolol Tartrate 5mg/5ml (1mg/ml)","code_information":[{"code":"3060762","type":"CDM"},{"code":"250","type":"RC"},{"code":"40917","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phenylephrine Hcl 10mg/ml","code_information":[{"code":"3000235","type":"CDM"},{"code":"636","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Handlg&/or Convey Spec For Tr Office-lab","code_information":[{"code":"8400398","type":"CDM"},{"code":"450","type":"RC"},{"code":"99000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":19,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Nicotine Patch","code_information":[{"code":"8401124","type":"CDM"},{"code":"450","type":"RC"},{"code":"S4990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Dobutamine 12.5 Mg/ml 20ml Vial","code_information":[{"code":"3000078","type":"CDM"},{"code":"636","type":"RC"},{"code":"40923","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Nicoderm Cq 21mg Patch","code_information":[{"code":"3000218","type":"CDM"},{"code":"636","type":"RC"},{"code":"43598044874","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Rifampin 300 Mg Caps","code_information":[{"code":"3060806","type":"CDM"},{"code":"250","type":"RC"},{"code":"61748001860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Injection Dopamine Hcl 40 Mg","code_information":[{"code":"8400895","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Nf-ambien Oral Tablet 10mg","code_information":[{"code":"3061191","type":"CDM"},{"code":"250","type":"RC"},{"code":"55289079206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nf-ambien Oral Tablet 5mg","code_information":[{"code":"3061474","type":"CDM"},{"code":"24540","type":"CPT","modifier":"131"}],"standard_charges":[{"setting":"outpatient","modifier_code":["131"],"minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Kayexalate (Sodium Polystyrene) 15g/60ml","code_information":[{"code":"3060916","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Rocuronium Bromide 10mg/ml 5ml","code_information":[{"code":"3000258","type":"CDM"},{"code":"636","type":"RC"},{"code":"40995","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rocuronium Up To 10mg","code_information":[{"code":"8401013","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ace Wraplt Compres Band >=5/yd","code_information":[{"code":"8401302","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Triamcinolone Acet Inj Nos","code_information":[{"code":"8400955","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Potassium Phosphate 25x5ml","code_information":[{"code":"3000245","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323008605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Losartan Potassium 25mg Tabs","code_information":[{"code":"3000168","type":"CDM"},{"code":"636","type":"RC"},{"code":"68084034601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":18,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sterile Water Irrigation 500ml Btl","code_information":[{"code":"3000287","type":"CDM"},{"code":"258","type":"RC"},{"code":"26421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Padding For Compression Bandage Roll","code_information":[{"code":"8401364","type":"CDM"},{"code":"450","type":"RC"},{"code":"S8430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Ace Wrap (Lt Compres Band >=3 <5/yd)","code_information":[{"code":"8401301","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":18,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Sensorcaine W/ Epi 0.5% 50ml","code_information":[{"code":"3000262","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323046357","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":18,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Solu-medrol Methylprednisolone 125mg/2ml","code_information":[{"code":"8400949","type":"CDM"},{"code":"250","type":"RC"},{"code":"90047","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":18,"maximum":18,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ondansetron Oral","code_information":[{"code":"8401100","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q0162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":17,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Etomidate 20mg/10ml V 10/b","code_information":[{"code":"8400983","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":17,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lidocaine 1% With Epi 30ml","code_information":[{"code":"3000150","type":"CDM"},{"code":"636","type":"RC"},{"code":"40931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":17,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Hydrocodone/apap 10/325 Tab","code_information":[{"code":"3000120","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":17,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Solu-medrol Methylprednisolone 80 Mg Inj","code_information":[{"code":"8400883","type":"CDM"},{"code":"450","type":"RC"},{"code":"70300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":17,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Sodium Polystyrene","code_information":[{"code":"8401083","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Irrigation Tray","code_information":[{"code":"8401184","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Irrigation Syringe","code_information":[{"code":"8401185","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Norepinephrine","code_information":[{"code":"8401006","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gentamicin 80mg/2ml Inj","code_information":[{"code":"3000107","type":"CDM"},{"code":"636","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Doc First Line Amox","code_information":[{"code":"8400856","type":"CDM"},{"code":"450","type":"RC"},{"code":"G9315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Medical Records Copying Fee Admin","code_information":[{"code":"8400436","type":"CDM"},{"code":"450","type":"RC"},{"code":"S9981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Medical Records Copying Fee Per Page","code_information":[{"code":"8400437","type":"CDM"},{"code":"450","type":"RC"},{"code":"S9982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Heparin Sodium Iv 1000un/500ml","code_information":[{"code":"3060870","type":"CDM"},{"code":"250","type":"RC"},{"code":"40976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1000,"type":"UN"}},{"description":"Labetalol Hcl 5mg/ml 20 Ml","code_information":[{"code":"3000137","type":"CDM"},{"code":"636","type":"RC"},{"code":"17478042020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Famotidine/tab 20mg","code_information":[{"code":"8401065","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tramadol/ultram Tab 50mg","code_information":[{"code":"8401091","type":"CDM"},{"code":"636","type":"RC"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Emesis Basin","code_information":[{"code":"8401163","type":"CDM"},{"code":"270","type":"RC"},{"code":"99070","type":"CPT","modifier":"EMES"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EMES"],"minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Chlorhexidine Antisept","code_information":[{"code":"8401179","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":16,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Digoxin Injection","code_information":[{"code":"8400887","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Promethazine (Phenergan) 25mg Supp","code_information":[{"code":"3060834","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dextrose 5% / Water 500ml","code_information":[{"code":"3000068","type":"CDM"},{"code":"258","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Bagurinary Leg Or Abdomen Bag","code_information":[{"code":"8401196","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Prolene 5-0 P-3","code_information":[{"code":"8401254","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU14"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU14"],"minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Prolene 4-0 P-3","code_information":[{"code":"8401255","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU15"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU15"],"minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Vicryl 5-o Ps-3","code_information":[{"code":"8401259","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU19"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU19"],"minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Silk 0 2c-2","code_information":[{"code":"8401262","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU3"],"minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Ethlon 4-0 Ps-2","code_information":[{"code":"8401268","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"SU9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SU9"],"minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Sodium Chloride 1000ml Irrigation","code_information":[{"code":"3000276","type":"CDM"},{"code":"636","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Levalbuterol Non-comp Con","code_information":[{"code":"8401038","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone 5mg Tab","code_information":[{"code":"3000231","type":"CDM"},{"code":"250","type":"RC"},{"code":"40605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Albuterol Non-comp Con","code_information":[{"code":"3061749","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol Comp Con","code_information":[{"code":"8401036","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Albuterol Non-comp Con","code_information":[{"code":"8401037","type":"CDM"},{"code":"636","type":"RC"},{"code":"48799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol Non-comp Unit","code_information":[{"code":"8401039","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Albuterol Ipratrop Non-comp","code_information":[{"code":"8401042","type":"CDM"},{"code":"636","type":"RC"},{"code":"37896","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gauzenon-sterile Gauze<=16 Sq In","code_information":[{"code":"8401284","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Gz Imprg W/ot H2ons/hydrgl Strl16sq/<w/a","code_information":[{"code":"8401286","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Gentamycin 40mg/ml 2ml Vial","code_information":[{"code":"3000108","type":"CDM"},{"code":"636","type":"RC"},{"code":"85015","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":15,"maximum":15,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Stadol (Butorphanol Tartrate 1 Mg)","code_information":[{"code":"8400870","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Conform Band N/s W<3/yd","code_information":[{"code":"8401297","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Conform Band S W>=3 <5/yd","code_information":[{"code":"8401299","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Hydrocort Sodium Phosphate 50mg Inj/<","code_information":[{"code":"8400907","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Hydrocort Inj Sodium Succinate 100mg/<","code_information":[{"code":"8400908","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Sodium Chloride 0.9% 250ml Inj","code_information":[{"code":"3000274","type":"CDM"},{"code":"636","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Amiodarone Hcl 30mg","code_information":[{"code":"8400860","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Injection Naltrexone Depot Form 1 Mg","code_information":[{"code":"8400929","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Protonix 40mg Per Vial","code_information":[{"code":"3000255","type":"CDM"},{"code":"636","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pantoprazole/ns Ivpb : 40mg/100ml","code_information":[{"code":"3060723","type":"CDM"},{"code":"258","type":"RC"},{"code":"99999999999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Atropine 0.4mg/ml Sdv 1ml","code_information":[{"code":"3000025","type":"CDM"},{"code":"636","type":"RC"},{"code":"51704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Inj Prohance 10ml","code_information":[{"code":"3060822","type":"CDM"},{"code":"636","type":"RC"},{"code":"27011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Sod Citrate & Citric Acid 1.5gm/1gm 15ml","code_information":[{"code":"3000279","type":"CDM"},{"code":"250","type":"RC"},{"code":"12105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Bolus Iv Lock Push Inj Hep Sodium Per10u","code_information":[{"code":"8400902","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Heparin Lock Flush 100u/ml 5ml","code_information":[{"code":"3000115","type":"CDM"},{"code":"636","type":"RC"},{"code":"63807060055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Levalbuterol 1.25mg/3ml","code_information":[{"code":"3000140","type":"CDM"},{"code":"636","type":"RC"},{"code":"35573044525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":14,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vecuronium Bromide 10mg","code_information":[{"code":"3000311","type":"CDM"},{"code":"636","type":"RC"},{"code":"47335093144","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"5% Dextrose/0.45% Saline 1000ml","code_information":[{"code":"8401156","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Sensorcaine 0.25% 30 Ml","code_information":[{"code":"3000260","type":"CDM"},{"code":"636","type":"RC"},{"code":"40911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Acet/tylenol #3 With Codeine 300mg Oral","code_information":[{"code":"8400967","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Polytrim Opthalmic Polymyxin","code_information":[{"code":"8401007","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Viscous Lidocaine Po 10ml","code_information":[{"code":"8401019","type":"CDM"},{"code":"636","type":"RC"},{"code":"50383077504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Clonidine/ Catapres Tab 0.1mg Po","code_information":[{"code":"8401056","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Metoprolol Tartrate Tab 50mg","code_information":[{"code":"8401076","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Viscous Lidocaine Po 10ml","code_information":[{"code":"8401092","type":"CDM"},{"code":"636","type":"RC"},{"code":"50383077504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Acet/tylenol #3 With Codeine 300mg Oral","code_information":[{"code":"8401126","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5000","type":"HCPCS","modifier":"ACET3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ACET3"],"minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Clonidine/catapres Tab 0.1mg Po","code_information":[{"code":"8401134","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"CLON"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CLON"],"minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Metoprolol Tartrate 50mg Po","code_information":[{"code":"8401145","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"MET50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["MET50"],"minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Viscous Lidocaine Po 10ml","code_information":[{"code":"8401153","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"VISLI"}],"standard_charges":[{"setting":"outpatient","modifier_code":["VISLI"],"minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Famotidine/ Pepcid 20mg Tablet","code_information":[{"code":"8400849","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"FAMO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["FAMO"],"minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Hot/cold H2obot/cap/col/wrap","code_information":[{"code":"8401314","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Levofloxacin (Levaquin) 500mg Tab","code_information":[{"code":"3000143","type":"CDM"},{"code":"636","type":"RC"},{"code":"55111028050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Caffiene Citrate Inj 5mg","code_information":[{"code":"8400878","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Flumazenil 0.1mg/ml 10ml","code_information":[{"code":"3000099","type":"CDM"},{"code":"636","type":"RC"},{"code":"36000014910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Needle Sterile Any Size Each","code_information":[{"code":"8401171","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Catheter Thoracic Chest Tube 12 Fr","code_information":[{"code":"8401270","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"TCAT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCAT"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Catheter Thoracic Chest Tube 36 Fr","code_information":[{"code":"8401271","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"TCAT2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCAT2"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Catheter Thoracic Chest Tube 24 Fr","code_information":[{"code":"8401272","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"TCAT3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCAT3"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Catheter Thoracic Chest Tube 16 Fr","code_information":[{"code":"8401273","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"TCAT4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCAT4"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Catheter Thoracic Chest Tube 28 Fr","code_information":[{"code":"8401275","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"TCAT6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TCAT6"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Sulfam+tri Tab","code_information":[{"code":"8401087","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sulf+tri Tab Bactrim Ds","code_information":[{"code":"8401150","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"SULF"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SULF"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Sterile Water Irrig 1000ml Pour Bottle","code_information":[{"code":"3000285","type":"CDM"},{"code":"258","type":"RC"},{"code":"99079","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ketorolac 60mg/2ml","code_information":[{"code":"3000136","type":"CDM"},{"code":"250","type":"RC"},{"code":"40937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Hydrocodone B +Ac Tab 5-325","code_information":[{"code":"8401066","type":"CDM"},{"code":"636","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azithromycin (Zithromax) 250mg Tab","code_information":[{"code":"3000027","type":"CDM"},{"code":"636","type":"RC"},{"code":"50111078810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Iv Start Kit","code_information":[{"code":"8401237","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"IV"}],"standard_charges":[{"setting":"outpatient","modifier_code":["IV"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Iv Extension Set 0.22 Micron Filter","code_information":[{"code":"8401238","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"IV2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["IV2"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Donnatol 10 Ml","code_information":[{"code":"8400981","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Hydrocodone/apap 5-325mg Tab","code_information":[{"code":"3000121","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Clindamycin Hcl/cap 150mg","code_information":[{"code":"8401055","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lumbar Puncture Tray Adult 20x3 1/2","code_information":[{"code":"8500805","type":"CDM"},{"code":"A4649","type":"HCPCS","modifier":"LMBR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LMBR"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Lumbar Puncture Tray Pedi 22gx1 1/2","code_information":[{"code":"8500806","type":"CDM"},{"code":"A4649","type":"HCPCS","modifier":"LMBR2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LMBR2"],"minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Lidocaine 2% With Epi 50ml","code_information":[{"code":"3000157","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323048357","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":13,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Bismuth Subsalicylate (Pepto) 525mg/30ml","code_information":[{"code":"3060839","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000003201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":525,"type":"ME"}},{"description":"Thiamine Hcl 100 Mg","code_information":[{"code":"8400960","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Racemic Epinephrine","code_information":[{"code":"8401012","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vicodin","code_information":[{"code":"8401018","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bed Pan Standard","code_information":[{"code":"8401323","type":"CDM"},{"code":"450","type":"RC"},{"code":"E0275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Sterile Gauze > 48 Sq In","code_information":[{"code":"8401292","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Versed Inj Midazolam Hydrochlord Per 1mg","code_information":[{"code":"8400925","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Lt Compres Band <3/yd","code_information":[{"code":"8401300","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Midazolam 1 Mg / Ml 2ml","code_information":[{"code":"3000200","type":"CDM"},{"code":"636","type":"RC"},{"code":"40923","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Vitamin D 5000 Units","code_information":[{"code":"3000314","type":"CDM"},{"code":"636","type":"RC"},{"code":"20555003300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Glipizide (Glucotrol) 5mg Tab","code_information":[{"code":"3060808","type":"CDM"},{"code":"250","type":"RC"},{"code":"90466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Straight Tip Urine Catheter","code_information":[{"code":"8401193","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Tamsulosin Hcl 0.4mg Caps","code_information":[{"code":"3000294","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084029901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Disposable Linershield Pad","code_information":[{"code":"8401368","type":"CDM"},{"code":"450","type":"RC"},{"code":"T4535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Bss Soln 36x15ml Balanced Salt Solution","code_information":[{"code":"3000036","type":"CDM"},{"code":"250","type":"RC"},{"code":"65079","type":"CPT","modifier":"515"}],"standard_charges":[{"setting":"outpatient","modifier_code":["515"],"minimum":12,"maximum":12,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Sterile Saline/water Mtr Ds Disp 10ml","code_information":[{"code":"8401174","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Gauze 2x2 4x4","code_information":[{"code":"8401291","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nf-cardizem Tablet 120mg","code_information":[{"code":"3061572","type":"CDM"},{"code":"250","type":"RC"},{"code":"18707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Heparin 10,000 Units","code_information":[{"code":"3000112","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323054201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Flumazenil Vl 0.1mg/ml 5m","code_information":[{"code":"8400986","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Stryker Kwire 0.62","code_information":[{"code":"2800504","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Ranitidine Hydrochloride Inj","code_information":[{"code":"8400944","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Hydrocortisone Cream 1% 1oz","code_information":[{"code":"3000122","type":"CDM"},{"code":"636","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Composite Dressing Sterile >16<=48 Sq In","code_information":[{"code":"8401283","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Ketamine 50mg/ml 10ml","code_information":[{"code":"3000133","type":"CDM"},{"code":"636","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ephedrine Sulf Inj 50mg/ml 1ml Amp","code_information":[{"code":"3060792","type":"CDM"},{"code":"636","type":"RC"},{"code":"17478041510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tape Non-waterproof","code_information":[{"code":"8401200","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Tape Waterproof","code_information":[{"code":"8401201","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Methylprednisolone Injection","code_information":[{"code":"8400948","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":11,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Oropharyngeal Suction Cath","code_information":[{"code":"8401210","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Alcohol 480ml 99%","code_information":[{"code":"3000013","type":"CDM"},{"code":"636","type":"RC"},{"code":"39512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":480,"type":"ML"}},{"description":"Brevibloc 10mg/ml","code_information":[{"code":"3000035","type":"CDM"},{"code":"636","type":"RC"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lidocaine 1% With Epi","code_information":[{"code":"8400994","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine 2% With Epi","code_information":[{"code":"8400995","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Scalpel Safety #11","code_information":[{"code":"8401219","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"BLAD"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BLAD"],"minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Canister Nondisposable Used W/suctn Pmp","code_information":[{"code":"8401307","type":"CDM"},{"code":"450","type":"RC"},{"code":"A7001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Levofloxacin 750mg/150ml Premix","code_information":[{"code":"3000144","type":"CDM"},{"code":"636","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"D5w/sodium Chl 0.9% 1000ml Iv","code_information":[{"code":"3060872","type":"CDM"},{"code":"258","type":"RC"},{"code":"26476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":924,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Lidocaine 2% 10x5ml Lido","code_information":[{"code":"3000153","type":"CDM"},{"code":"636","type":"RC"},{"code":"40920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ceftazidime (Fortaz) 1gm Vl","code_information":[{"code":"3000047","type":"CDM"},{"code":"636","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Oximeter Non-invasive","code_information":[{"code":"6400004","type":"CDM"},{"code":"270","type":"RC"},{"code":"E0445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Potassium Chloride 10meq/100ml","code_information":[{"code":"3000241","type":"CDM"},{"code":"636","type":"RC"},{"code":"57402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Lidocaine With Epi 0.5% 50ml","code_information":[{"code":"3000162","type":"CDM"},{"code":"636","type":"RC"},{"code":"40931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Coban/co-flex Bandage","code_information":[{"code":"8401160","type":"CDM"},{"code":"270","type":"RC"},{"code":"99070","type":"CPT","modifier":"COBAN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["COBAN"],"minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Steri Strips","code_information":[{"code":"8401249","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"STERI"}],"standard_charges":[{"setting":"outpatient","modifier_code":["STERI"],"minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Metoprolol Tartrate 25mg Po","code_information":[{"code":"8401361","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"MET25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["MET25"],"minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Chlorhexidine Gluconate 0.12% Oral Rinse","code_information":[{"code":"3060789","type":"CDM"},{"code":"250","type":"RC"},{"code":"11620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":924,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tobramycin 40mg/ml 2ml","code_information":[{"code":"3000300","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fentanyl 100mcg/2ml","code_information":[{"code":"3000095","type":"CDM"},{"code":"636","type":"RC"},{"code":"40990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Transparent Film <= 16 Sq In","code_information":[{"code":"8401289","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Lidocaine 1% Pf 30ml","code_information":[{"code":"3000149","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323049237","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Refresh Lacrilube 3.5gm","code_information":[{"code":"3000173","type":"CDM"},{"code":"250","type":"RC"},{"code":"23031","type":"CPT","modifier":"204"}],"standard_charges":[{"setting":"outpatient","modifier_code":["204"],"minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":35,"type":"GR"}},{"description":"Lidocaine Jelly 2% 5ml","code_information":[{"code":"3000159","type":"CDM"},{"code":"250","type":"RC"},{"code":"1747871110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Lidocaine 1% 30ml","code_information":[{"code":"3000148","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323048707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Pedialyte/ Rtf Fruit 1l Btl","code_information":[{"code":"8401081","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine With Epinephrine 1% 50ml","code_information":[{"code":"3000163","type":"CDM"},{"code":"636","type":"RC"},{"code":"40942","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Solu-medrol Methylprednisolone 40 Mg Inj","code_information":[{"code":"8400882","type":"CDM"},{"code":"450","type":"RC"},{"code":"55154394005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ketoralac 30 Mg/ml 25x1","code_information":[{"code":"3000134","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Metronidazole (Flagyl)500mg/100ml Premix","code_information":[{"code":"3000199","type":"CDM"},{"code":"636","type":"RC"},{"code":"33810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lidocaine 1% With Epi 1:100,000 50ml Mdv","code_information":[{"code":"3000151","type":"CDM"},{"code":"636","type":"RC"},{"code":"40931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Furosemide 10mg/ml 2ml Vial","code_information":[{"code":"3000102","type":"CDM"},{"code":"636","type":"RC"},{"code":"40961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Inhalation Solution","code_information":[{"code":"8401048","type":"CDM"},{"code":"450","type":"RC"},{"code":"J7699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Olanzapine 1 Mg Long-acting Injection","code_information":[{"code":"8400930","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Olanzapine 1 Mg Long-acting Injection","code_information":[{"code":"8500930","type":"CDM"},{"code":"J2358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Nitro-bid (Nitroglycerin Ointment) 2% 1g","code_information":[{"code":"3060771","type":"CDM"},{"code":"250","type":"RC"},{"code":"28103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":1232,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1232},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Canister Disposable Used W/suction Pump","code_information":[{"code":"8401306","type":"CDM"},{"code":"450","type":"RC"},{"code":"A7000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Raconic 0.5ml","code_information":[{"code":"8401011","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Urinary Catheter Anchoring Dvc Leg Strap","code_information":[{"code":"8401189","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Sensorcaine 0.5% With Epi 30ml","code_information":[{"code":"3000261","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Benadryl 12.5mg/5ml Childrens Liquid","code_information":[{"code":"3000030","type":"CDM"},{"code":"636","type":"RC"},{"code":"73480015004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Oxycontin Ext-release Tablet 20mg","code_information":[{"code":"3060878","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Heparin Sodium Porcine 5000 Units/ml","code_information":[{"code":"3000116","type":"CDM"},{"code":"636","type":"RC"},{"code":"72603041225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Inj Visipaque","code_information":[{"code":"3060826","type":"CDM"},{"code":"636","type":"RC"},{"code":"40722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prednisone 5mg Tab","code_information":[{"code":"3000246","type":"CDM"},{"code":"636","type":"RC"},{"code":"54872","type":"CPT","modifier":"425"}],"standard_charges":[{"setting":"outpatient","modifier_code":["425"],"minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ibuprofen Childrens Elixir","code_information":[{"code":"8400851","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"IBUPS"}],"standard_charges":[{"setting":"outpatient","modifier_code":["IBUPS"],"minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Ibuprofen Childrens Elixir","code_information":[{"code":"8401068","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylprednisolone 20 Mg Inj","code_information":[{"code":"8400881","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Tylenol W/ Codeine Liq 120mg-12mg/5ml","code_information":[{"code":"3060833","type":"CDM"},{"code":"250","type":"RC"},{"code":"12105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Lidocaine Patch Er 5%","code_information":[{"code":"3060890","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347050505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Morphine 4mg/ml","code_information":[{"code":"3000206","type":"CDM"},{"code":"636","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Hydromorphone 2mg/ml 1ml","code_information":[{"code":"3000123","type":"CDM"},{"code":"636","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Npo Challenge","code_information":[{"code":"8400317","type":"CDM"},{"code":"450","type":"RC"},{"code":"6020F","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Mag Al Plus Xs 30ml (Maalox)","code_information":[{"code":"3000020","type":"CDM"},{"code":"636","type":"RC"},{"code":"12117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Aspirin 325 Mg Tablet","code_information":[{"code":"3000022","type":"CDM"},{"code":"636","type":"RC"},{"code":"12843053635","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Non Prescription Otc","code_information":[{"code":"8400843","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Aspirin Tab 324mg","code_information":[{"code":"8400846","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"ASP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ASP"],"minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Maalox 30cc","code_information":[{"code":"8400852","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"MAL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["MAL"],"minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Aspirin Tablet 325 Mg","code_information":[{"code":"8400855","type":"CDM"},{"code":"450","type":"RC"},{"code":"G8598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Maalox 30 Cc","code_information":[{"code":"8400998","type":"CDM"},{"code":"636","type":"RC"},{"code":"12117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Multivitamin Inj","code_information":[{"code":"8401020","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS","modifier":"VIT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["VIT"],"minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Preloneoral Prednisolone Per 5 Mg","code_information":[{"code":"8401032","type":"CDM"},{"code":"450","type":"RC"},{"code":"12107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Aspirin Tab/325mg","code_information":[{"code":"8401053","type":"CDM"},{"code":"636","type":"RC"},{"code":"5789692101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Prescription Drug Brand Name","code_information":[{"code":"8401129","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Nitroglycerin Sl 0.4mg","code_information":[{"code":"8401146","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"NITR"}],"standard_charges":[{"setting":"outpatient","modifier_code":["NITR"],"minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Bacitraicin 500u/1gm","code_information":[{"code":"3060772","type":"CDM"},{"code":"258","type":"RC"},{"code":"90233","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Exten Drain Tubing Any Type Any Length","code_information":[{"code":"8401187","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":8,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Dextrose 5 0.45 Ns 20 Kcl 1000ml","code_information":[{"code":"3000067","type":"CDM"},{"code":"636","type":"RC"},{"code":"26476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":924,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Ef Adult Fluids And Electro","code_information":[{"code":"8401316","type":"CDM"},{"code":"450","type":"RC"},{"code":"B4102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Cardizem 5mg/ml","code_information":[{"code":"3000041","type":"CDM"},{"code":"636","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diabetic Tussin Liq 200mg/5ml 118ml Btl","code_information":[{"code":"3061989","type":"CDM"},{"code":"250","type":"RC"},{"code":"6056906404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fluor-i-strip 9mg For Dialation Of Eyes","code_information":[{"code":"8400987","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Lube Sterile Packet","code_information":[{"code":"8401188","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"20 Plus Cc Syringe Only","code_information":[{"code":"8401170","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Syringe With Or Without Needle","code_information":[{"code":"8401278","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Pyridium/phenazopyridine 200mg Po","code_information":[{"code":"8401010","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pyridium/phenazopyridine 200mg Po","code_information":[{"code":"8401149","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"PYRI"}],"standard_charges":[{"setting":"outpatient","modifier_code":["PYRI"],"minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Propofol 200mg/20ml 20ml","code_information":[{"code":"3000252","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323026937","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Potassium Chloride Er 10meq Po","code_information":[{"code":"3000243","type":"CDM"},{"code":"636","type":"RC"},{"code":"24553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl Patch 25mcg/hr","code_information":[{"code":"3060938","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fentanyl Patch 50mcg/hr","code_information":[{"code":"3060941","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Supply Not Otherwise Specified","code_information":[{"code":"8401369","type":"CDM"},{"code":"450","type":"RC"},{"code":"T5999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":7,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Sumatriptan Succinate / 6 Mg","code_information":[{"code":"8400952","type":"CDM"},{"code":"450","type":"RC"},{"code":"J3030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Rocuronium Bromide","code_information":[{"code":"8401014","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Injection Propranolol Hcl Up To 1 Mg","code_information":[{"code":"8400911","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Lidocaine 2% With Epi 20ml","code_information":[{"code":"3000156","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323048902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Gz Imprg W/ot H2ons/hydrgl Strl>48sqin","code_information":[{"code":"8401287","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Sulfamethoxazole & Trimethoprim 800/160","code_information":[{"code":"3000291","type":"CDM"},{"code":"636","type":"RC"},{"code":"90427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prelone Inj Prednisolone Acetate 1 Ml/<","code_information":[{"code":"8400938","type":"CDM"},{"code":"450","type":"RC"},{"code":"J2650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Acetaminophen Mapap Tab 500mg Ud","code_information":[{"code":"8400844","type":"CDM"},{"code":"450","type":"RC"},{"code":"69618001101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Acetaminophen/ Tylenol Elixir 160mg","code_information":[{"code":"8400845","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"ACETS"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ACETS"],"minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Benadryl / Diphenhydramine 25mg Po","code_information":[{"code":"8400847","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"BENA"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BENA"],"minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Benadryl / Diphenydramine Elixir","code_information":[{"code":"8400848","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"BENAE"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BENAE"],"minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Ibuprofen (Motrin) 200 Mg Tab Oral","code_information":[{"code":"8400850","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"IBUP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["IBUP"],"minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Imodium/ Loperamide Po","code_information":[{"code":"8400853","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9150","type":"HCPCS","modifier":"MOD"}],"standard_charges":[{"setting":"outpatient","modifier_code":["MOD"],"minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Afrin Nasal Spray (Oxymetazoline)","code_information":[{"code":"8400968","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aspirin Tablet 81mg Po","code_information":[{"code":"8400969","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":81,"type":"ME"}},{"description":"Benadryl/diphenhydramine 25mg Po","code_information":[{"code":"8400970","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Imodium/loperamide Po","code_information":[{"code":"8400988","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prednisone Oral 1mg","code_information":[{"code":"8401033","type":"CDM"},{"code":"636","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":50,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Acetaminophen Liquid/tab/supp","code_information":[{"code":"8401050","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ibuprofen 200mg Tab Oral","code_information":[{"code":"8401067","type":"CDM"},{"code":"636","type":"RC"},{"code":"30904791461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Acetaminophen Mapap Tab 500mg Ud","code_information":[{"code":"8401074","type":"CDM"},{"code":"636","type":"RC"},{"code":"30904673061","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meclizine 25mg Chew Tab","code_information":[{"code":"8401075","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nitroquick Sl 0.4mg Tablet","code_information":[{"code":"8401079","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Potassium Chl 10meq Oral","code_information":[{"code":"8401084","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Potassium Chl 20meq Oral","code_information":[{"code":"8401085","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diphenhydramine Hcl 25mg Tab W/chemo","code_information":[{"code":"8401101","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q0163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Meclizine 25mg","code_information":[{"code":"8401144","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"MECL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["MECL"],"minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Potassium Chl 20meq Oral","code_information":[{"code":"8401148","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"POT20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["POT20"],"minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Lisinopril 5mg Tabs","code_information":[{"code":"3000165","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084019601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Magnesium Citrate 296ml","code_information":[{"code":"3000175","type":"CDM"},{"code":"636","type":"RC"},{"code":"70677111101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":296,"type":"ML"}},{"description":"Mag Sulf 5gm/10ml Inj","code_information":[{"code":"3060816","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Cannula Nasal O2","code_information":[{"code":"8401209","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Swab Or Wipe Skin Barrier","code_information":[{"code":"8401282","type":"CDM"},{"code":"450","type":"RC"},{"code":"A5120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Sterile Eye Pad Or Strip","code_information":[{"code":"8401294","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Tracheostomy Care Kit","code_information":[{"code":"8401211","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Dextrose 5% In Lactated Ringers 1000 Ml","code_information":[{"code":"3000071","type":"CDM"},{"code":"258","type":"RC"},{"code":"26477","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":924,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"EPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":924},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Prednisone 10mg Tab","code_information":[{"code":"3060831","type":"CDM"},{"code":"250","type":"RC"},{"code":"60353","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vitamin K","code_information":[{"code":"4000392","type":"CDM"},{"code":"300","type":"RC"},{"code":"84597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Lidocaine 2% Pf 5ml","code_information":[{"code":"3000155","type":"CDM"},{"code":"636","type":"RC"},{"code":"72603050525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Lidocaine 2% 20ml","code_information":[{"code":"3000154","type":"CDM"},{"code":"636","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Promethazine 25mg Tab","code_information":[{"code":"3000249","type":"CDM"},{"code":"636","type":"RC"},{"code":"90464","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydroxyzine Pamoate 25mg","code_information":[{"code":"8401103","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q0177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Hydroxyzine 25mg Po","code_information":[{"code":"8401140","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5001","type":"HCPCS","modifier":"HYD"}],"standard_charges":[{"setting":"outpatient","modifier_code":["HYD"],"minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Acetaminophen Codeine 300/30mg","code_information":[{"code":"3000004","type":"CDM"},{"code":"636","type":"RC"},{"code":"40604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Hydrocodone/acet 7.5/325mg/15ml","code_information":[{"code":"3060942","type":"CDM"},{"code":"250","type":"RC"},{"code":"12123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Marcaine Spinal 2ml Amp","code_information":[{"code":"3060924","type":"CDM"},{"code":"250","type":"RC"},{"code":"71351002210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Heparin 1000 Units 1ml","code_information":[{"code":"3000113","type":"CDM"},{"code":"636","type":"RC"},{"code":"72603023425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1000,"type":"UN"}},{"description":"Adhesive Bandage First-aid","code_information":[{"code":"8401296","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Self-adher Band W>=3 <5/yd","code_information":[{"code":"8401304","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Cardizemdiltiazem Hydrochloride 10 Mg","code_information":[{"code":"8400975","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Augmentin (Amoxil/clav) 875-125mg Tab","code_information":[{"code":"3060830","type":"CDM"},{"code":"250","type":"RC"},{"code":"78118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Marcaine 0.5% 10ml","code_information":[{"code":"3000182","type":"CDM"},{"code":"636","type":"RC"},{"code":"40911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Acetaminophen 160mg/5ml Children Elix","code_information":[{"code":"3000001","type":"CDM"},{"code":"636","type":"RC"},{"code":"50580061401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Celebrex 200 Mg Tab","code_information":[{"code":"3000049","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097042107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Urine Reagent Strips/tablets","code_information":[{"code":"8401180","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Nf-valsartan Oral Tablet 80mg","code_information":[{"code":"3061452","type":"CDM"},{"code":"250","type":"RC"},{"code":"37858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Fleets Enema Adult 4.50z","code_information":[{"code":"3000097","type":"CDM"},{"code":"250","type":"RC"},{"code":"13202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ice Pack","code_information":[{"code":"8401236","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"ICE"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ICE"],"minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Decadrondexamethasone Sodium Phos 1mg","code_information":[{"code":"8400885","type":"CDM"},{"code":"250","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Oral Dexamethason .25mg","code_information":[{"code":"8401095","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Alcohol Or Peroxide Per Pint","code_information":[{"code":"8401176","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Metronidazole/sol 500mg/100ml100ml","code_information":[{"code":"8401000","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metoclopramide 5mg/ml 2ml Vial","code_information":[{"code":"3000195","type":"CDM"},{"code":"636","type":"RC"},{"code":"40934","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Protonix 40mg Tabs","code_information":[{"code":"3000256","type":"CDM"},{"code":"636","type":"RC"},{"code":"51079005120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Topical Anesthetic Per Gram","code_information":[{"code":"8401279","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Phenytoin Ex 100mg Tab","code_information":[{"code":"3000237","type":"CDM"},{"code":"636","type":"RC"},{"code":"65162021210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Polyethylene Glycol (Miralax) 17gm","code_information":[{"code":"3000203","type":"CDM"},{"code":"636","type":"RC"},{"code":"11523726803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":17,"type":"GR"}},{"description":"Extension Set Iv Ultra/rate Flow","code_information":[{"code":"8401235","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"EXTS"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EXTS"],"minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Esomeprazole  Delayed Release 20mg Tab","code_information":[{"code":"3000090","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598050930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Loratadine (Claritin) 24hr 10mg Tab","code_information":[{"code":"3060856","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268048915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lidocaine 1% 100mg/5ml 5ml Ansyr","code_information":[{"code":"3000146","type":"CDM"},{"code":"636","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sodium Chloridie 3000ml Irrigation","code_information":[{"code":"3000278","type":"CDM"},{"code":"258","type":"RC"},{"code":"40979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ciprofloxacin 500mg Tab","code_information":[{"code":"3000056","type":"CDM"},{"code":"636","type":"RC"},{"code":"90463","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Butorphanol (Stadol) 2mg/ml","code_information":[{"code":"3060926","type":"CDM"},{"code":"250","type":"RC"},{"code":"40916","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lidocaine 1% 10mg/ml 20ml Vial","code_information":[{"code":"3000147","type":"CDM"},{"code":"636","type":"RC"},{"code":"40942","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Enalapril 1.25mg/ml Vial","code_information":[{"code":"3000084","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Methocarbamol 500mg Tab","code_information":[{"code":"3000190","type":"CDM"},{"code":"636","type":"RC"},{"code":"43547040510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Zofran 4mg Po Odt (Ondansetron)","code_information":[{"code":"8401094","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ondansetron Zofran Odt 4 Mg","code_information":[{"code":"8401122","type":"CDM"},{"code":"250","type":"RC"},{"code":"S0119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Lubricant Per Ounce","code_information":[{"code":"8401199","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Propofol 10mg","code_information":[{"code":"8401009","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Conform Band N/s W>=3<5/yd","code_information":[{"code":"8401298","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Marcaine O.25% Epi 10ml Pf","code_information":[{"code":"3000183","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Carmex Stick","code_information":[{"code":"3000042","type":"CDM"},{"code":"250","type":"RC"},{"code":"83078011317","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Urine Cup Female Collect Dev Cup","code_information":[{"code":"8401186","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Gloves Sterile Per Pair","code_information":[{"code":"8401281","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Gz N-imprg Strl Pd>16sq In<48sq In W/adh","code_information":[{"code":"8401285","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Dulcolax 10mg Supp","code_information":[{"code":"3000082","type":"CDM"},{"code":"636","type":"RC"},{"code":"81421002102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vecuronium 1 Mg/ml 10mg/10ml","code_information":[{"code":"3060944","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335093144","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Blood Glucose/reagent Strips","code_information":[{"code":"8401181","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Droperidol Injection","code_information":[{"code":"8400910","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Acetaminophen (Tylenol)  80mg Supp Infan","code_information":[{"code":"3000003","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672211402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Bacteriostatic Water 30ml","code_information":[{"code":"3000029","type":"CDM"},{"code":"636","type":"RC"},{"code":"40939","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Lidocaine Pf 1% 2ml","code_information":[{"code":"3000160","type":"CDM"},{"code":"636","type":"RC"},{"code":"40947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Ondansetron (Zofran) 8mg Tab","code_information":[{"code":"3060835","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462015813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Urine Specimen Collection Kit","code_information":[{"code":"8401233","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CUP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CUP"],"minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Urine Cup Contain Spec W/lid Unwrap","code_information":[{"code":"8401234","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"CUP2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CUP2"],"minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Nasal Deconges Nasal Spray (Afrin) 15ml","code_information":[{"code":"3000215","type":"CDM"},{"code":"250","type":"RC"},{"code":"41100081123","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Clindamycin 300mg Tabs","code_information":[{"code":"3000058","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762501001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Vital Signs Recorded","code_information":[{"code":"8400138","type":"CDM"},{"code":"450","type":"RC"},{"code":"2010F","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Mental Status Assessed","code_information":[{"code":"8400139","type":"CDM"},{"code":"450","type":"RC"},{"code":"2014F","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Atropine Sulfate Injection 0.01mg","code_information":[{"code":"8400866","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Levoleucovorin Injection","code_information":[{"code":"8400872","type":"CDM"},{"code":"450","type":"RC"},{"code":"J0641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Injection Piperacillin Sodi","code_information":[{"code":"8401121","type":"CDM"},{"code":"450","type":"RC"},{"code":"S0081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Prescription Drug Generic","code_information":[{"code":"8401125","type":"CDM"},{"code":"450","type":"RC"},{"code":"S5000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Gloves Non-sterile","code_information":[{"code":"8401280","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Bandageself-adher Band W <3o/yd","code_information":[{"code":"8401303","type":"CDM"},{"code":"450","type":"RC"},{"code":"A6453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Hyoscyamine 0.125mg Odt Tab","code_information":[{"code":"3000124","type":"CDM"},{"code":"250","type":"RC"},{"code":"43199001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Alcohol Prep Pad Large","code_information":[{"code":"8401241","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"PAD"}],"standard_charges":[{"setting":"outpatient","modifier_code":["PAD"],"minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Alcohol Prep Pad Medium","code_information":[{"code":"8401242","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"PAD2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["PAD2"],"minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Isosorbide Dn 20mg Tab","code_information":[{"code":"3000130","type":"CDM"},{"code":"250","type":"RC"},{"code":"78116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Metoprolol Succinate 5mg/5ml (1mg/ml)","code_information":[{"code":"3060763","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP3060763","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nf-colace Oral Capsule, Liquid Filled 50","code_information":[{"code":"3060849","type":"CDM"},{"code":"250","type":"RC"},{"code":"67618011128","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nf-aspirin         Tab  81mg","code_information":[{"code":"3060980","type":"CDM"},{"code":"250","type":"RC"},{"code":"50090055201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":81,"type":"ME"}},{"description":"Nf-protonix Oral Tab Dr 20mg","code_information":[{"code":"3061665","type":"CDM"},{"code":"80843","type":"CPT","modifier":"81"}],"standard_charges":[{"setting":"outpatient","modifier_code":["81"],"minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Ondansetron Tabs Odt 4mg","code_information":[{"code":"3000229","type":"CDM"},{"code":"636","type":"RC"},{"code":"62756024064","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nasal Decongestant","code_information":[{"code":"8401078","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lorazepam 2 Mg/ml","code_information":[{"code":"3000167","type":"CDM"},{"code":"636","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Cetirizine 10mg Tab","code_information":[{"code":"3000051","type":"CDM"},{"code":"636","type":"RC"},{"code":"90467","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Meloxicam 7.5mg Tab","code_information":[{"code":"3000186","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382005001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Celecoxib (Celebrex) 400mg Cap","code_information":[{"code":"3060914","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762151802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Guaifenesin (Mucinex) Xr 1200mg Tab","code_information":[{"code":"3060862","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824002335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Ondansetron Hcl 4mg Tabs","code_information":[{"code":"3000228","type":"CDM"},{"code":"636","type":"RC"},{"code":"90465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Silver Nitrate Stick","code_information":[{"code":"3000265","type":"CDM"},{"code":"636","type":"RC"},{"code":"12870000102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bacitracin Ointment 0.5oz","code_information":[{"code":"3000028","type":"CDM"},{"code":"636","type":"RC"},{"code":"45802006070","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zolpidem Tartrate 5mg Tab","code_information":[{"code":"3000316","type":"CDM"},{"code":"250","type":"RC"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Omnipaquelocm 300-399mg/ml Iodine 1ml","code_information":[{"code":"8401114","type":"CDM"},{"code":"450","type":"RC"},{"code":"40714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Insulin Humulin 100un/ml","code_information":[{"code":"3000127","type":"CDM"},{"code":"636","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Carvedilol 6.25mg Tab","code_information":[{"code":"3000043","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079093020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Loperamide 2mg Tab","code_information":[{"code":"3000166","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580033818","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Famotidine 10mg Tabs","code_information":[{"code":"3000093","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001049406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Acetaminophen Supp 120 Mg","code_information":[{"code":"3000006","type":"CDM"},{"code":"636","type":"RC"},{"code":"45802073230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Clonidine 0.1mg Po","code_information":[{"code":"3000060","type":"CDM"},{"code":"250","type":"RC"},{"code":"22821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Diazepam 5mg Tab","code_information":[{"code":"3000073","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlodipine 5mg Tab","code_information":[{"code":"3000017","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877019890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Gabapentin 300mg Tab","code_information":[{"code":"3000104","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877022301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Misoprostol 100mcg","code_information":[{"code":"3000204","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386016006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gabapentin (Neurontin) 100 Mg Capsule","code_information":[{"code":"3060787","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877022201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amlodipine Besylate 10mg Tabs","code_information":[{"code":"3060793","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382012305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Visipaque-locm 320 1ml","code_information":[{"code":"8401115","type":"CDM"},{"code":"450","type":"RC"},{"code":"Q9967","type":"HCPCS","modifier":"V"}],"standard_charges":[{"setting":"outpatient","modifier_code":["V"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Acetaminophen Codeine Elix","code_information":[{"code":"3060935","type":"CDM"},{"code":"250","type":"RC"},{"code":"12105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Taztia Xt Cap 120mg","code_information":[{"code":"8401090","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Nitroglycerin 0.4mg Sl Tabs","code_information":[{"code":"3000220","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762330403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Hydrocodone / Acet 7.5/325mg","code_information":[{"code":"3000119","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Oxycodone 10mg Tab","code_information":[{"code":"3000230","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084096801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Metoprolol Tartrate 50mg Tab","code_information":[{"code":"3000198","type":"CDM"},{"code":"250","type":"RC"},{"code":"37800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Diphenhydramine 25mg Caps","code_information":[{"code":"3000077","type":"CDM"},{"code":"636","type":"RC"},{"code":"90453","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metoprolol Tartrate 25mg Tabs","code_information":[{"code":"3000197","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332011231","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bethanechol 10mg Tab","code_information":[{"code":"3000032","type":"CDM"},{"code":"636","type":"RC"},{"code":"83205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluconazole (Diflucan) 150 Mg Tab","code_information":[{"code":"3060774","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762501701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Milk Of Magnesia 30ml","code_information":[{"code":"3060922","type":"CDM"},{"code":"250","type":"RC"},{"code":"12104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Amiodarone 200mg Tabs","code_information":[{"code":"3000015","type":"CDM"},{"code":"250","type":"RC"},{"code":"24501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Morphine 2mg/ml Carpuject","code_information":[{"code":"3060915","type":"CDM"},{"code":"636","type":"RC"},{"code":"40918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Vitamin C 500mg","code_information":[{"code":"3000313","type":"CDM"},{"code":"636","type":"RC"},{"code":"90405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Doxycycline Mono/cap 100mg","code_information":[{"code":"8401062","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Phenytoin","code_information":[{"code":"8401082","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Keppra Levetiracetam 10mg","code_information":[{"code":"8400919","type":"CDM"},{"code":"450","type":"RC"},{"code":"J1953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Sucralfate Carafate 1gm X 100","code_information":[{"code":"3000289","type":"CDM"},{"code":"250","type":"RC"},{"code":"93221","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cephalexin 500mg Tab","code_information":[{"code":"3000050","type":"CDM"},{"code":"250","type":"RC"},{"code":"93314","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Simethicone (Gas-x) 125mg Chewable Tab","code_information":[{"code":"3060838","type":"CDM"},{"code":"250","type":"RC"},{"code":"67012","type":"CPT","modifier":"918"}],"standard_charges":[{"setting":"outpatient","modifier_code":["918"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Bisacodyl (Dulcolax) 5mg Tab","code_information":[{"code":"3060842","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135015461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bandage Fabric Strip 1x3 Inch","code_information":[{"code":"8401216","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"BAND"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BAND"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Bandage Fabric Patch 2x3 Inch","code_information":[{"code":"8401217","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"BAND2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BAND2"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Bandage Fabric Patch 2x4 Inch","code_information":[{"code":"8401218","type":"CDM"},{"code":"450","type":"RC"},{"code":"A4649","type":"HCPCS","modifier":"BAND3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["BAND3"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Wound Closure By Adhesive","code_information":[{"code":"800001","type":"CDM"},{"code":"270","type":"RC"},{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Ammonia Aromatic 10 Inhalant","code_information":[{"code":"3000018","type":"CDM"},{"code":"636","type":"RC"},{"code":"46414333303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Losartan Potassium 50mg Tabs","code_information":[{"code":"3000169","type":"CDM"},{"code":"636","type":"RC"},{"code":"68084034701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Furosemide 40mg Tab","code_information":[{"code":"3000103","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079007320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Phenazopyridine Hcl (Azo) 95mg Tab","code_information":[{"code":"3060809","type":"CDM"},{"code":"250","type":"RC"},{"code":"49973030131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Benzoin Tincture/ampule","code_information":[{"code":"8400971","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anti Diarrheal Capl 2mg","code_information":[{"code":"8401052","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Non-covered Item Or Service","code_information":[{"code":"8401313","type":"CDM"},{"code":"450","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Tramadol 50mg Tab","code_information":[{"code":"3000301","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Senna (Senokot) 8.6mg Tab","code_information":[{"code":"3060840","type":"CDM"},{"code":"250","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":195,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":195}]}],"drug_information":{"unit":86,"type":"ME"}},{"description":"Pseudoephedrine (Sudafed) 30mg Tab","code_information":[{"code":"3060858","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580054524","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cyclobenzaprine 5mg Tabs","code_information":[{"code":"3000062","type":"CDM"},{"code":"250","type":"RC"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Acetaminophen 325mg Tab","code_information":[{"code":"3000002","type":"CDM"},{"code":"636","type":"RC"},{"code":"63629151801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Acetaminophen 325mg Suppository","code_information":[{"code":"3060934","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Ibuprofen 200mg Tabs","code_information":[{"code":"3000125","type":"CDM"},{"code":"250","type":"RC"},{"code":"57301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tylenol Es 500mg Tab","code_information":[{"code":"3000307","type":"CDM"},{"code":"636","type":"RC"},{"code":"45004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cepacol Honey Lemon Throat Lozenge","code_information":[{"code":"3000054","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824073216","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nifedipine Xr 60mg Tab","code_information":[{"code":"3060814","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742026101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Triple Antibiotic Ointment Packet","code_information":[{"code":"3000305","type":"CDM"},{"code":"636","type":"RC"},{"code":"45802014370","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atenolol 25mg Tab","code_information":[{"code":"3000024","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079075920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metformin Hcl Xr 500mg Tab","code_information":[{"code":"3000188","type":"CDM"},{"code":"250","type":"RC"},{"code":"49483062309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin (Glucophage) 500 Mg Tab","code_information":[{"code":"3060783","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Atenolol 50mg Tabs","code_information":[{"code":"3060794","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079068420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Famotidine (Pepcid) 20mg Tab","code_information":[{"code":"3060843","type":"CDM"},{"code":"250","type":"RC"},{"code":"90457","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lorazepam 0.5mg Tab (Ativan)","code_information":[{"code":"3060933","type":"CDM"},{"code":"250","type":"RC"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluorscein Ophthalmic Strips","code_information":[{"code":"3000100","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP3000100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clonazepam 0.5mg Tab (Klonopin)","code_information":[{"code":"3060932","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687054401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"Blue Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Texas","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}}],"last_updated_on":"2026-04-01","location_name":["Baytown Medical Center"],"hospital_address":["1626 West Baker Road, Baytown, TX 77521"],"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":"Mahvish Khan"},"type_2_npi":["1457820995"],"license_information":{"license_number":"100254","state":"TX"},"version":"3.0.0"}