{"hospital_name":"Castro County Hospital District","standard_charge_information":[{"description":"64633 Destroy C/th Facet Jnt 1st Levelbi-lateral Pain Charge","code_information":[{"code":"49064633B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7862,"maximum":8354,"gross_charge":9828,"discounted_cash":7371,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8354},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7862},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7862},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7862},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8354}]}]},{"description":"64635 Destrov 1/s Facet Jnt 1st Levelbi-lateral Pain Charge","code_information":[{"code":"49064635B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7862,"maximum":8354,"gross_charge":9828,"discounted_cash":7371,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8354},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7862},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7862},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7862},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8354}]}]},{"description":"64624 Genicular Nerve Ablationbi-lateral Pain Charge","code_information":[{"code":"49064624B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7860,"maximum":8351,"gross_charge":9825,"discounted_cash":7369,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8351},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7860},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7860},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8351}]}]},{"description":"26765 Open Tx Phalangeal Fx Ed Charge","code_information":[{"code":"44526765","type":"CDM"},{"code":"450","type":"RC"},{"code":"26765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6490,"maximum":6895,"gross_charge":8112,"discounted_cash":6084,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6895},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6490},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6490},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6490},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6895}]}]},{"description":"23930 I&d Up Arm Elbw Deep Absc","code_information":[{"code":"44523930","type":"CDM"},{"code":"450","type":"RC"},{"code":"23930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5414,"maximum":5753,"gross_charge":6768,"discounted_cash":5076,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5753},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5414},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5414},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5414},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5753}]}]},{"description":"Cchd Bone Imaging, 3 Phase","code_information":[{"code":"4340001","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5037,"maximum":5352,"gross_charge":6296,"discounted_cash":4722,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5352},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5037},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5037},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5037},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5352}]}]},{"description":"64624 Genicular Nerve Ablation Pain Charge","code_information":[{"code":"49064624","type":"CDM"},{"code":"761","type":"RC"},{"code":"64624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4183,"maximum":4445,"gross_charge":5229,"discounted_cash":3922,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4445},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4445}]}]},{"description":"64633 Destroy C/th Facet Jnt 1st Level Pain Charge","code_information":[{"code":"49064633","type":"CDM"},{"code":"761","type":"RC"},{"code":"64633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4183,"maximum":4445,"gross_charge":5229,"discounted_cash":3922,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4445},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4445}]}]},{"description":"64635 Destroy L/s Facet Jnt 1st Level Pain Charge","code_information":[{"code":"49064635","type":"CDM"},{"code":"761","type":"RC"},{"code":"64635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4183,"maximum":4445,"gross_charge":5229,"discounted_cash":3922,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4445},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4445}]}]},{"description":"64493 Ini Paravert F Jnt L/s 1 Levelbi-lateral Pain Charge","code_information":[{"code":"49064493B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3978,"maximum":4226,"gross_charge":4972,"discounted_cash":3729,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4226},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3978},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3978},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3978},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4226}]}]},{"description":"64490 Inj Paravert Facet Jnt C/t 1 Levelbi-lateral Pain Charge","code_information":[{"code":"49064490B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3978,"maximum":4226,"gross_charge":4972,"discounted_cash":3729,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4226},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3978},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3978},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3978},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4226}]}]},{"description":"64630 Destruction Pudendal Nerve Bilateral [Cchd]","code_information":[{"code":"49064630B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3474,"maximum":3691,"gross_charge":4342,"discounted_cash":3257,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3691},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3691}]}]},{"description":"64640 Destruction By Neruolytic Agent Other Nerve Bilateral  [Cchd]","code_information":[{"code":"49064640B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3474,"maximum":3691,"gross_charge":4342,"discounted_cash":3257,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3691},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3691}]}]},{"description":"64454 Njx Genicular Diagnostic Blockbi- Lateral Pain Charge","code_information":[{"code":"49064454B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3140,"maximum":3336,"gross_charge":3925,"discounted_cash":2944,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3336},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3140},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3140},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3336}]}]},{"description":"20520 Rmvl Fb Smp Muscle/tendon","code_information":[{"code":"44520520","type":"CDM"},{"code":"450","type":"RC"},{"code":"20520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3090,"maximum":3283,"gross_charge":3862,"discounted_cash":2897,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3283},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3090},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3090},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3090},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3283}]}]},{"description":"24200 Rmvl Fb U Arm Elbw Subq","code_information":[{"code":"44524200","type":"CDM"},{"code":"450","type":"RC"},{"code":"24200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3090,"maximum":3283,"gross_charge":3862,"discounted_cash":2897,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3283},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3090},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3090},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3090},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3283}]}]},{"description":"25605 Fx Dis Rad Clsd W Manipul","code_information":[{"code":"4453099","type":"CDM"},{"code":"761","type":"RC"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3062,"maximum":3254,"gross_charge":3828,"discounted_cash":2871,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3254},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3062},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3062},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3062},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3254}]}]},{"description":"Insert Picc Wo Port >5yrs Charge","code_information":[{"code":"4476490","type":"CDM"},{"code":"761","type":"RC"},{"code":"36569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3052,"maximum":3243,"gross_charge":3815,"discounted_cash":2861,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3243},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3052},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3052},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3052},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3243}]}]},{"description":"Picc Line Insertion","code_information":[{"code":"4456490","type":"CDM"},{"code":"36569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3052,"maximum":3243,"gross_charge":3815,"discounted_cash":2861,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3243},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3052},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3052},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3052},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3243}]}]},{"description":"99460 Int Care, Norm Nb","code_information":[{"code":"4456280","type":"CDM"},{"code":"450","type":"RC"},{"code":"99460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2974,"maximum":3160,"gross_charge":3718,"discounted_cash":2789,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3160},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2974},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2974},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2974},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3160}]}]},{"description":"20606 Xyphoid Jnt Inj (With Ultrasound Bi- Lateral Pain Charge","code_information":[{"code":"49020606B","type":"CDM"},{"code":"761","type":"RC"},{"code":"20606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2828,"maximum":3005,"gross_charge":3535,"discounted_cash":2651,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3005},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2828},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2828},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2828},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3005}]}]},{"description":"26951 Amputation, Finger Or Thumb, Single, W/ Direct Clsr","code_information":[{"code":"4453985","type":"CDM"},{"code":"450","type":"RC"},{"code":"26951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2782,"maximum":2955,"gross_charge":3477,"discounted_cash":2608,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2955},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2782},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2782},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2782},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2955}]}]},{"description":"64450 Other Peripheral Nerve Block Pain Charge","code_information":[{"code":"49064450B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2636,"maximum":2801,"gross_charge":3295,"discounted_cash":2471,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2801},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2801}]}]},{"description":"Trauma Team Activation Level 4","code_information":[{"code":"4453007","type":"CDM"},{"code":"684","type":"RC"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2609,"maximum":2772,"gross_charge":3261,"discounted_cash":2446,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2772},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2609},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2609},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2609},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2772}]}]},{"description":"27372 Removal Fb Thighknee Deep","code_information":[{"code":"4453995","type":"CDM"},{"code":"450","type":"RC"},{"code":"27372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2445,"maximum":2598,"gross_charge":3056,"discounted_cash":2292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2598},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2445},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2445},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2445},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2598}]}]},{"description":"Ct Abdomen/pelvis W + W/o Contrast","code_information":[{"code":"4360312-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74178","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2243,"maximum":2383,"gross_charge":2804,"discounted_cash":2103,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2383}]}]},{"description":"Injection(s) of anesthetic into lower spine using imaging guidance","code_information":[{"code":"49064483","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2241,"maximum":2381,"gross_charge":2801,"discounted_cash":2101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2381},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2381}]}]},{"description":"64490 Inj Paravert F Jnt C/t 1 Level Pain Charge","code_information":[{"code":"49064490","type":"CDM"},{"code":"761","type":"RC"},{"code":"64490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2241,"maximum":2381,"gross_charge":2801,"discounted_cash":2101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2381},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2381}]}]},{"description":"64493 Ini Paravert F Jnt L/s 1 Level Pain Charge","code_information":[{"code":"49064493","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2241,"maximum":2381,"gross_charge":2801,"discounted_cash":2101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2381},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2241},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2381}]}]},{"description":"27096 Inject Sacroiliac Jointbi-lateral Pain Charge","code_information":[{"code":"49027096B","type":"CDM"},{"code":"761","type":"RC"},{"code":"27096","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2232,"maximum":2372,"gross_charge":2790,"discounted_cash":2093,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2372},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2372}]}]},{"description":"64421 Nix Aa&/strd Intercostal  Nerve Block Pain Charge","code_information":[{"code":"49064421","type":"CDM"},{"code":"761","type":"RC"},{"code":"64421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1929,"maximum":2049,"gross_charge":2411,"discounted_cash":1808,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2049},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1929},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1929},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1929},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2049}]}]},{"description":"62321 Interlaminar Inj Cervical Or Thoracic (Esi) Pain Charge","code_information":[{"code":"49062321","type":"CDM"},{"code":"761","type":"RC"},{"code":"62321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1822,"maximum":1935,"gross_charge":2277,"discounted_cash":1708,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1935},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1935}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"49062323","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1822,"maximum":1935,"gross_charge":2277,"discounted_cash":1708,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1935},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1935}]}]},{"description":"64451 Nix Aa&/strd Nrv Nrvtg Si It Pain Charge","code_information":[{"code":"49064451","type":"CDM"},{"code":"761","type":"RC"},{"code":"64451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1822,"maximum":1935,"gross_charge":2277,"discounted_cash":1708,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1935},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1935}]}]},{"description":"64454 Njx Genicular Diagnostic Block Pain Charge","code_information":[{"code":"49064454","type":"CDM"},{"code":"761","type":"RC"},{"code":"64454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1822,"maximum":1935,"gross_charge":2277,"discounted_cash":1708,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1935},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1822},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1935}]}]},{"description":"11752 Ex Nail W Tuft Amputation","code_information":[{"code":"4453988","type":"CDM"},{"code":"761","type":"RC"},{"code":"26236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1813,"maximum":1926,"gross_charge":2266,"discounted_cash":1700,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1926},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1926}]}]},{"description":"Partial Excision Distal Phalanx Of Toe","code_information":[{"code":"4454051","type":"CDM"},{"code":"761","type":"RC"},{"code":"28124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1813,"maximum":1926,"gross_charge":2266,"discounted_cash":1700,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1926},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1926}]}]},{"description":"Ct Angiography Abdomen/pelvis","code_information":[{"code":"4360402-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74174","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1786,"maximum":1898,"gross_charge":2233,"discounted_cash":1675,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1898},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1786},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1786},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1786},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1898}]}]},{"description":"CT scan of abdomen and pelvis with contrast","code_information":[{"code":"4360310-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74177","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1781,"maximum":1892,"gross_charge":2226,"discounted_cash":1670,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1781},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1781},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1781},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1892}]}]},{"description":"64510 Stellate Ganglion (Cervical  Sympathetic) Pain Charge","code_information":[{"code":"49064510","type":"CDM"},{"code":"761","type":"RC"},{"code":"64510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1737,"maximum":1845,"gross_charge":2171,"discounted_cash":1628,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845}]}]},{"description":"64520 Ganglion Impar Block Pain Charge","code_information":[{"code":"49064520","type":"CDM"},{"code":"761","type":"RC"},{"code":"64520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1737,"maximum":1845,"gross_charge":2171,"discounted_cash":1628,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845}]}]},{"description":"64630 Destruction Pudendal Nerve Unilateral [Cchd]","code_information":[{"code":"49064630","type":"CDM"},{"code":"761","type":"RC"},{"code":"64630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1737,"maximum":1845,"gross_charge":2171,"discounted_cash":1628,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845}]}]},{"description":"64640 Continuous Ablation Suprascapular Nerve/suprascapular Nerve Rfa Peripheral *Pulse Pain Charge","code_information":[{"code":"49064640","type":"CDM"},{"code":"761","type":"RC"},{"code":"64640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1737,"maximum":1845,"gross_charge":2171,"discounted_cash":1628,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845}]}]},{"description":"Transport Specialty Care","code_information":[{"code":"4531232","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1737,"maximum":1845,"gross_charge":2171,"discounted_cash":1628,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845}]}]},{"description":"15200 Autogrf Acell Full Thick","code_information":[{"code":"4453989","type":"CDM"},{"code":"761","type":"RC"},{"code":"15200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1731,"maximum":1839,"gross_charge":2164,"discounted_cash":1623,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1839},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1731},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1731},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1731},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1839}]}]},{"description":"Rpr Lay S,ax,t,ex,g;>30cm","code_information":[{"code":"4453046","type":"CDM"},{"code":"761","type":"RC"},{"code":"12037","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1731,"maximum":1839,"gross_charge":2164,"discounted_cash":1623,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1839},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1731},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1731},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1731},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1839}]}]},{"description":"49082 Paracentesis Abd Wo Image","code_information":[{"code":"44549082","type":"CDM"},{"code":"450","type":"RC"},{"code":"49082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1727,"maximum":1835,"gross_charge":2159,"discounted_cash":1619,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1835},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1727},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1727},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1727},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1835}]}]},{"description":"Mra Neck W/ + W/o Contrast","code_information":[{"code":"4320062-TC","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Abdomen W/ + W/o Contrast","code_information":[{"code":"4320014-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"MRI Scan","code_information":[{"code":"4320001-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"70553","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Face Neck Orbit W/ + W/o Contrast","code_information":[{"code":"4320009-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"70543","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Le Joint W/ + W/o Contrast Right","code_information":[{"code":"4320090-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Le Non Joint W/ + W/o Contrast Bilat","code_information":[{"code":"4320076-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Lower Exremity Non Joint W/wo Contrast Left","code_information":[{"code":"4320086-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Lower Extremity Non Joint W/wo Contrast Right","code_information":[{"code":"4320087-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Pelvis W/ + W/o Contrast","code_information":[{"code":"4320015-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"72197","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Spine Cervical W/ + W/o Contrast","code_information":[{"code":"4320013-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Spine Lumbar W/ + W/o Contrast","code_information":[{"code":"4320006-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Spine Thoracic W/ + W/o Contrast","code_information":[{"code":"4320011-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Ue Non Joint W/ + W/o Contrast Left","code_information":[{"code":"4320094-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"Mri Ue Non Joint W/ + W/o Contrast Right","code_information":[{"code":"4320095-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1716,"maximum":1823,"gross_charge":2145,"discounted_cash":1609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"99291- Ed Critical Care-1st Hour","code_information":[{"code":"4453011","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1691,"maximum":1797,"gross_charge":2114,"discounted_cash":1586,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1797},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1691},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1691},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1691},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1797}]}]},{"description":"Ct Spine Lumbar W/ + W/o Contrast","code_information":[{"code":"4360159","type":"CDM"},{"code":"350","type":"RC"},{"code":"72133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1670,"maximum":1775,"gross_charge":2088,"discounted_cash":1566,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1775},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1670},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1670},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1670},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1775}]}]},{"description":"12047 Rpr Lay;n,h,ft,g;>30cm","code_information":[{"code":"4453052","type":"CDM"},{"code":"761","type":"RC"},{"code":"12047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649,"maximum":1752,"gross_charge":2061,"discounted_cash":1546,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1752},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1752}]}]},{"description":"20101 Explore Penetrating Wound; Chest","code_information":[{"code":"4456493","type":"CDM"},{"code":"761","type":"RC"},{"code":"20101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649,"maximum":1752,"gross_charge":2061,"discounted_cash":1546,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1752},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1649},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1752}]}]},{"description":"Bcid2 Panel Filmarray","code_information":[{"code":"4300010","type":"CDM"},{"code":"300","type":"RC"},{"code":"87150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1610,"maximum":1710,"gross_charge":2012,"discounted_cash":1509,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1710},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1610},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1610},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1610},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1710}]}]},{"description":"54001 Slit Prepuce, Except Nb","code_information":[{"code":"4454060","type":"CDM"},{"code":"761","type":"RC"},{"code":"54001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1577,"maximum":1675,"gross_charge":1971,"discounted_cash":1478,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1675},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1577},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1577},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1577},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1675}]}]},{"description":"Etonogestrel 68 Mg Implant (Nexplanon) [Cchd]","code_information":[{"code":"J7307","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1574,"maximum":1672,"gross_charge":1967,"discounted_cash":1475,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1672},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1574},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1574},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1574},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1672}]}]},{"description":"Mri Abdomen W/ Contrast","code_information":[{"code":"4320019-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1560,"maximum":1658,"gross_charge":1950,"discounted_cash":1463,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658}]}]},{"description":"Mri Brain W/ Contrast","code_information":[{"code":"4320010-TC","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1560,"maximum":1658,"gross_charge":1950,"discounted_cash":1463,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658}]}]},{"description":"Mri Spine Cervical W/ Contrast","code_information":[{"code":"4320101-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1560,"maximum":1658,"gross_charge":1950,"discounted_cash":1463,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658}]}]},{"description":"Mri Spine Lumbar W/ Contrast","code_information":[{"code":"4320017-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1560,"maximum":1658,"gross_charge":1950,"discounted_cash":1463,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658}]}]},{"description":"56440 Marsupial Bartholins Cyst","code_information":[{"code":"4453982","type":"CDM"},{"code":"761","type":"RC"},{"code":"56440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1554,"maximum":1651,"gross_charge":1942,"discounted_cash":1457,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1651},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1554},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1554},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1554},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1651}]}]},{"description":"Mri Lower Extremity Joint W/ Contrast Right","code_information":[{"code":"4320091-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1526,"maximum":1621,"gross_charge":1907,"discounted_cash":1430,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1621},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1526},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1526},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1526},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1621}]}]},{"description":"64450 Injection Aa&/strd Other Peripheral Nerve/branch","code_information":[{"code":"49064450","type":"CDM"},{"code":"761","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1510,"maximum":1604,"gross_charge":1887,"discounted_cash":1415,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1604},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1604}]}]},{"description":"20606 Intermediate Jt/bursa W/i [Cchd]","code_information":[{"code":"49020606","type":"CDM"},{"code":"761","type":"RC"},{"code":"20606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1510,"maximum":1604,"gross_charge":1887,"discounted_cash":1415,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1604},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1604}]}]},{"description":"64420 Intercostal  Nerve (Single) Pain Charge","code_information":[{"code":"49064420","type":"CDM"},{"code":"761","type":"RC"},{"code":"64420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1510,"maximum":1604,"gross_charge":1887,"discounted_cash":1415,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1604},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1604}]}]},{"description":"64425 Nix Aa&/strd Ii Ih Nerves Pain Charge","code_information":[{"code":"49064425","type":"CDM"},{"code":"761","type":"RC"},{"code":"64425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1510,"maximum":1604,"gross_charge":1887,"discounted_cash":1415,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1604},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1510},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1604}]}]},{"description":"Mra Abdomen W/ + W/o Contrast","code_information":[{"code":"4320054-TC","type":"CDM"},{"code":"618","type":"RC"},{"code":"74185","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1482,"maximum":1574,"gross_charge":1852,"discounted_cash":1389,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1574},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1482},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1482},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1482},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1574}]}]},{"description":"Transport Als2","code_information":[{"code":"4530009","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1470,"maximum":1561,"gross_charge":1837,"discounted_cash":1378,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1561},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1470},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1470},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1470},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1561}]}]},{"description":"23505 Fx Clavicular Clsd W Mani","code_information":[{"code":"4453084","type":"CDM"},{"code":"761","type":"RC"},{"code":"23505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1419,"maximum":1508,"gross_charge":1774,"discounted_cash":1331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508}]}]},{"description":"24655 Fx Rad He/nk Clsd W Manip","code_information":[{"code":"4453092","type":"CDM"},{"code":"761","type":"RC"},{"code":"24655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1419,"maximum":1508,"gross_charge":1774,"discounted_cash":1331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508}]}]},{"description":"25505 Fx Rad Shft Clsd W Manipu","code_information":[{"code":"4453094","type":"CDM"},{"code":"761","type":"RC"},{"code":"25505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1419,"maximum":1508,"gross_charge":1774,"discounted_cash":1331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508}]}]},{"description":"25565 Fx Clsd Tx Rad Uln Sh Wma","code_information":[{"code":"4456084","type":"CDM"},{"code":"761","type":"RC"},{"code":"25565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1419,"maximum":1508,"gross_charge":1774,"discounted_cash":1331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508}]}]},{"description":"26645 Fx Dslc Thumb Clsd W Mani","code_information":[{"code":"4453105","type":"CDM"},{"code":"761","type":"RC"},{"code":"26645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1419,"maximum":1508,"gross_charge":1774,"discounted_cash":1331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508}]}]},{"description":"27752 Fx Clsd Tx Tiv Shft W Man","code_information":[{"code":"4453106","type":"CDM"},{"code":"761","type":"RC"},{"code":"27752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1419,"maximum":1508,"gross_charge":1774,"discounted_cash":1331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1508}]}]},{"description":"I&d Hematoma Fluid","code_information":[{"code":"4453014","type":"CDM"},{"code":"450","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418,"maximum":1506,"gross_charge":1772,"discounted_cash":1329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1506},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1506}]}]},{"description":"10121 Incision Rmvl Fb Sq Compl","code_information":[{"code":"4453199","type":"CDM"},{"code":"761","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418,"maximum":1506,"gross_charge":1772,"discounted_cash":1329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1506},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1506}]}]},{"description":"28192 Removal Fb Foot, Deep","code_information":[{"code":"4453189","type":"CDM"},{"code":"761","type":"RC"},{"code":"28192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418,"maximum":1506,"gross_charge":1772,"discounted_cash":1329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1506},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1506}]}]},{"description":"11044 Debrid Skin Sq Mus Bone","code_information":[{"code":"4453022","type":"CDM"},{"code":"761","type":"RC"},{"code":"11044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418,"maximum":1506,"gross_charge":1772,"discounted_cash":1329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1506},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1506}]}]},{"description":"Mra Head W/o Contrast","code_information":[{"code":"4320050-TC","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mra Neck W/o Contrast","code_information":[{"code":"4320060-TC","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Abdomen W/o Contrast","code_information":[{"code":"4320018-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"74181","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Brain W/o Contrast","code_information":[{"code":"4320005-TC","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Face Neck Orbit W/o Contrast","code_information":[{"code":"4320012-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"70540","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Le Joint W/ Contrast Bilateral","code_information":[{"code":"4320078-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"4320007-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Le Non Joint W/o Contrast Bilat","code_information":[{"code":"4320094","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"4320082-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"4320083-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Lower Extremity Non Joint W/o Contrast Left","code_information":[{"code":"4320092","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Lower Extremity Non Joint W/o Contrast Right","code_information":[{"code":"4320093","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Pelvis W/o Contrast","code_information":[{"code":"4320016-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"72195","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Spine Cervical W/o Contrast","code_information":[{"code":"4320003-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"MRI scan of lower spinal canal","code_information":[{"code":"4320004-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"72148","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Spine Thoracic W/o Contrast","code_information":[{"code":"4320002-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Ue Joint W/ Contrast Bilateral","code_information":[{"code":"4320077-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Ue Joint W/ Contrast Left","code_information":[{"code":"4320088-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Ue Joint W/ Contrast Right","code_information":[{"code":"4320089-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Ue Joint W/o Contrast Bilateral","code_information":[{"code":"4320008-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Ue Joint W/o Contrast Left","code_information":[{"code":"4320084-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Ue Joint W/o Contrast Right","code_information":[{"code":"4320085-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Ue Non Joint W/o Contrast Left","code_information":[{"code":"4320081-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Mri Ue Non Joint W/o Contrast Right","code_information":[{"code":"4320070-TC","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1404,"maximum":1492,"gross_charge":1755,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}]},{"description":"Ct Abdomen/pelvis W/o Contrast","code_information":[{"code":"4360311-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74176","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1385,"maximum":1471,"gross_charge":1731,"discounted_cash":1298,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1471},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1385},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1385},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1385},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1471}]}]},{"description":"27096 Iniect Sacroiliac Joint Pain Charge","code_information":[{"code":"49027096","type":"CDM"},{"code":"761","type":"RC"},{"code":"27096","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1368,"maximum":1454,"gross_charge":1710,"discounted_cash":1283,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1454},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1368},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1368},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1454}]}]},{"description":"62290 Nerve Sympathetic Block [Cchd]","code_information":[{"code":"49062290","type":"CDM"},{"code":"761","type":"RC"},{"code":"62290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1344,"maximum":1428,"gross_charge":1680,"discounted_cash":1260,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1428},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1428}]}]},{"description":"64634 Destroy C/th Facet Jnt Addlbi-lateral Pain Charge","code_information":[{"code":"49064634B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1344,"maximum":1428,"gross_charge":1680,"discounted_cash":1260,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1428},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1428}]}]},{"description":"64636 Destroy 1/s Facet Jnt Addlbi-lateral Pain Charge","code_information":[{"code":"49064636B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1344,"maximum":1428,"gross_charge":1680,"discounted_cash":1260,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1428},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1428}]}]},{"description":"10080 Incision And Drainage Of Pilonidal Cyst; Simple.","code_information":[{"code":"44510080","type":"CDM"},{"code":"761","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1341,"maximum":1425,"gross_charge":1676,"discounted_cash":1257,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425}]}]},{"description":"Amp Finger Any Jt W Flap","code_information":[{"code":"4453205","type":"CDM"},{"code":"450","type":"RC"},{"code":"26952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1322,"maximum":1404,"gross_charge":1652,"discounted_cash":1239,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1322},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1322},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1322},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1404}]}]},{"description":"20611 Joint Bursa Bilateral [Cchd]","code_information":[{"code":"49020611B","type":"CDM"},{"code":"761","type":"RC"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1321,"maximum":1403,"gross_charge":1651,"discounted_cash":1238,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1403},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1321},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1321},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1321},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1403}]}]},{"description":"62270 Dx Lmbr Spi Pnxr Pain Charge","code_information":[{"code":"49062270","type":"CDM"},{"code":"761","type":"RC"},{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1318,"maximum":1400,"gross_charge":1647,"discounted_cash":1235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"62273 Iniect Epidural Patch Pain Charge","code_information":[{"code":"49062273","type":"CDM"},{"code":"761","type":"RC"},{"code":"62273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1318,"maximum":1400,"gross_charge":1647,"discounted_cash":1235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"62328 Dx Lmbr Spi Pnxr W/fluor/ct Pain Charge","code_information":[{"code":"49062328","type":"CDM"},{"code":"761","type":"RC"},{"code":"62328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1318,"maximum":1400,"gross_charge":1647,"discounted_cash":1235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"64445 Sciatic Nerve Block Pain Charge","code_information":[{"code":"49064445","type":"CDM"},{"code":"761","type":"RC"},{"code":"64445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1318,"maximum":1400,"gross_charge":1647,"discounted_cash":1235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"64447 Njx Aa&/strd Femoral Nerve Block Pain Charge","code_information":[{"code":"49064447","type":"CDM"},{"code":"761","type":"RC"},{"code":"64447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1318,"maximum":1400,"gross_charge":1647,"discounted_cash":1235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"64625 Rf Abltj Nrv Nrvtg Si Jt Pain Charge","code_information":[{"code":"49064625","type":"CDM"},{"code":"761","type":"RC"},{"code":"64625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1318,"maximum":1400,"gross_charge":1647,"discounted_cash":1235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"64450 Inj Anes Oth Per Nerve","code_information":[{"code":"4456444","type":"CDM"},{"code":"761","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1318,"maximum":1400,"gross_charge":1647,"discounted_cash":1235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400}]}]},{"description":"Ct Chest W/ & W/o Contrast","code_information":[{"code":"4360125-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71270","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1313,"maximum":1395,"gross_charge":1641,"discounted_cash":1231,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1313},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1313},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1313},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395}]}]},{"description":"Ct Abdomen W/ + W/o Contrast","code_information":[{"code":"4360119-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74170","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1299,"maximum":1380,"gross_charge":1624,"discounted_cash":1218,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1380},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1299},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1299},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1299},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1380}]}]},{"description":"Ct Pelvis W/ + W/o Contrast","code_information":[{"code":"4360145-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72194","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1276,"maximum":1356,"gross_charge":1595,"discounted_cash":1196,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1356},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1276},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1276},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1276},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1356}]}]},{"description":"92960 Cardioversionelectrical, External Ed Charge","code_information":[{"code":"44592960","type":"CDM"},{"code":"450","type":"RC"},{"code":"92960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1240,"maximum":1318,"gross_charge":1550,"discounted_cash":1163,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1318}]}]},{"description":"99285- Ed Visit Level 5 High Decision Making","code_information":[{"code":"4453005","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1224,"maximum":1301,"gross_charge":1530,"discounted_cash":1148,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1301},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1301}]}]},{"description":"32554 Thoracentesis.","code_information":[{"code":"4457133","type":"CDM"},{"code":"761","type":"RC"},{"code":"32554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1197,"maximum":1272,"gross_charge":1496,"discounted_cash":1122,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272}]}]},{"description":"13121 Rpr Compx;sc,ex;2.6-7.5cm","code_information":[{"code":"4453064","type":"CDM"},{"code":"761","type":"RC"},{"code":"13121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1197,"maximum":1272,"gross_charge":1496,"discounted_cash":1122,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272}]}]},{"description":"21315 Fx Nasal Clsd W Manipulat","code_information":[{"code":"4453250","type":"CDM"},{"code":"761","type":"RC"},{"code":"21315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1197,"maximum":1272,"gross_charge":1496,"discounted_cash":1122,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272}]}]},{"description":"31603 Trach,emerg;transtracheal","code_information":[{"code":"4454036","type":"CDM"},{"code":"761","type":"RC"},{"code":"31603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1197,"maximum":1272,"gross_charge":1496,"discounted_cash":1122,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272}]}]},{"description":"Cva Device; Nt, 5 Yrs & Older Charge","code_information":[{"code":"4454037","type":"CDM"},{"code":"450","type":"RC"},{"code":"36556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1180,"maximum":1254,"gross_charge":1475,"discounted_cash":1106,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1254},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1254}]}]},{"description":"Cchd Ct Angiography Neck Tech","code_information":[{"code":"4360300-TC","type":"CDM"},{"code":"351","type":"RC"},{"code":"70498","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1160,"maximum":1233,"gross_charge":1450,"discounted_cash":1088,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1233},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1233}]}]},{"description":"Ct Angio Chest","code_information":[{"code":"4360158-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71275","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1160,"maximum":1233,"gross_charge":1450,"discounted_cash":1088,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1233},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1233}]}]},{"description":"Ct Angiography Abdomen","code_information":[{"code":"4360302-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74175","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1160,"maximum":1233,"gross_charge":1450,"discounted_cash":1088,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1233},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1233}]}]},{"description":"Ct Angiography Head","code_information":[{"code":"4360301-TC","type":"CDM"},{"code":"351","type":"RC"},{"code":"70496","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1160,"maximum":1233,"gross_charge":1450,"discounted_cash":1088,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1233},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1233}]}]},{"description":"64491 Ini Paravert Facet Jnt C/t 2 Level- Bi-lateral Pain Charge","code_information":[{"code":"49064491B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1152,"maximum":1224,"gross_charge":1440,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1224}]}]},{"description":"64492 Ini Paravert Facet Jnt C/t 3 Levelbi-lateral Pain Charge","code_information":[{"code":"49064492B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1152,"maximum":1224,"gross_charge":1440,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1224}]}]},{"description":"Aph Plt Acda Lr","code_information":[{"code":"4393128","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Aph Plt Acda Lr 1","code_information":[{"code":"4393132","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Aph Plt Acda Lr 2","code_information":[{"code":"4393133","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Aph Plt Acda Lr 3","code_information":[{"code":"4393134","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Aph Plt Acda Lr Irr 1","code_information":[{"code":"4393141","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Aph Plt Acda Lr Irr 2","code_information":[{"code":"4393142","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Aph Plt Acda Lr Irr 3","code_information":[{"code":"4393143","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Aph Plt Acda Lr Irr Var Con","code_information":[{"code":"4393144","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"Platelets, Pheresis, Leukocytes Reduced, Irradiate","code_information":[{"code":"4393135","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1208,"gross_charge":1421,"discounted_cash":1066,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1208}]}]},{"description":"20605 Xvohoid Ioint Iniection-bilateral Pain Charge","code_information":[{"code":"49020605B","type":"CDM"},{"code":"761","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1129,"maximum":1199,"gross_charge":1411,"discounted_cash":1058,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1199}]}]},{"description":"20610 Drain/inj  Joint/bursa W/o Us-bilateral Pain Charge","code_information":[{"code":"49020610B","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1129,"maximum":1199,"gross_charge":1411,"discounted_cash":1058,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1199}]}]},{"description":"64612 Bil Chemo Muscle Facial Nerve","code_information":[{"code":"49064612B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1129,"maximum":1199,"gross_charge":1411,"discounted_cash":1058,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1199}]}]},{"description":"64616 Chemodenervation Neck Muscles Bilateral","code_information":[{"code":"49064616B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64616","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1129,"maximum":1199,"gross_charge":1411,"discounted_cash":1058,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1199}]}]},{"description":"Ct Head Or Brain W/ + W/o Contrast","code_information":[{"code":"4360131-TC","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1123,"maximum":1193,"gross_charge":1404,"discounted_cash":1053,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193}]}]},{"description":"Ct Maxillofacial W/ + W/o Contrast","code_information":[{"code":"4360157-TC","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1123,"maximum":1193,"gross_charge":1404,"discounted_cash":1053,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193}]}]},{"description":"Ct Orbit Sella Etc. W/ + W/o Contrast","code_information":[{"code":"4360402","type":"CDM"},{"code":"350","type":"RC"},{"code":"70482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1123,"maximum":1193,"gross_charge":1404,"discounted_cash":1053,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193}]}]},{"description":"Ct Soft Tissue Neck W/ + W/o Contrast","code_information":[{"code":"4360130-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70492","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1123,"maximum":1193,"gross_charge":1404,"discounted_cash":1053,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193}]}]},{"description":"Ct Spine Cervical W/ Contrast","code_information":[{"code":"4360115-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72126","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1067,"maximum":1134,"gross_charge":1334,"discounted_cash":1001,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1134},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1067},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1067},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1067},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1134}]}]},{"description":"Ct Chest W/contrast","code_information":[{"code":"4360126-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71260","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1054,"maximum":1119,"gross_charge":1317,"discounted_cash":988,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1119},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1119}]}]},{"description":"Us Echocardiogram Complete","code_information":[{"code":"4430409-TC","type":"CDM"},{"code":"483","type":"RC"},{"code":"93306","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1051,"maximum":1117,"gross_charge":1314,"discounted_cash":986,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1117},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1051},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1051},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1051},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1117}]}]},{"description":"Ct Abdomen W/ Contrast","code_information":[{"code":"4360121-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74160","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1039,"maximum":1104,"gross_charge":1299,"discounted_cash":974,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1104},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1039},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1039},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1039},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1104}]}]},{"description":"CT scan of pelvis with contrast","code_information":[{"code":"4360144-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72193","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1021,"maximum":1085,"gross_charge":1276,"discounted_cash":957,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1085}]}]},{"description":"Transport Emerg Als1","code_information":[{"code":"4530008-ET","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0427","type":"HCPCS","modifier":"ET"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ET"],"minimum":1015,"maximum":1079,"gross_charge":1269,"discounted_cash":952,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1079},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1079}]}]},{"description":"27193 Fx Pelvic Ring Clsd Tx","code_information":[{"code":"4453983","type":"CDM"},{"code":"761","type":"RC"},{"code":"27197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":987,"maximum":1049,"gross_charge":1234,"discounted_cash":926,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1049},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":987},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":987},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":987},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1049}]}]},{"description":"15002 Surg Prep Creat Rec Site","code_information":[{"code":"4453991","type":"CDM"},{"code":"761","type":"RC"},{"code":"15002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":986,"maximum":1048,"gross_charge":1233,"discounted_cash":925,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1048},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":986},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":986},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":986},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1048}]}]},{"description":"20103 Explortn Penetrtg Wnd Ext","code_information":[{"code":"4453200","type":"CDM"},{"code":"761","type":"RC"},{"code":"20103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":978,"maximum":1040,"gross_charge":1223,"discounted_cash":917,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":978},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":978},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":978},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1040}]}]},{"description":"40654 Repair Lip > 1/2 Vert Ht","code_information":[{"code":"4453987","type":"CDM"},{"code":"761","type":"RC"},{"code":"40654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":974,"maximum":1034,"gross_charge":1217,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1034},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1034}]}]},{"description":"64494 Ini Oaravert F Jnt 1/s 2 Levelbi-lateral Pain Charge","code_information":[{"code":"49064494B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64494","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":960,"maximum":1020,"gross_charge":1200,"discounted_cash":900,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1020},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1020}]}]},{"description":"64495 Ini Paravert F Jnt L/s 3 Level- Bi-lateral Pain Charge","code_information":[{"code":"49064495B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":960,"maximum":1020,"gross_charge":1200,"discounted_cash":900,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1020},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1020}]}]},{"description":"37195 Thrombolysis Crbrl Iv","code_information":[{"code":"4456023","type":"CDM"},{"code":"761","type":"RC"},{"code":"37195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":946,"maximum":1006,"gross_charge":1183,"discounted_cash":887,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1006},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":946},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":946},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":946},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1006}]}]},{"description":"Adenovirus","code_information":[{"code":"4300768","type":"CDM"},{"code":"306","type":"RC"},{"code":"87633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942,"maximum":1001,"gross_charge":1178,"discounted_cash":884,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1001},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":942},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":942},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":942},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1001}]}]},{"description":"Ct Lower Extremity W/ Contrast Left","code_information":[{"code":"4360152-TC","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":905,"maximum":961,"gross_charge":1131,"discounted_cash":848,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961}]}]},{"description":"Ct Lower Extremity W/ Contrast Right","code_information":[{"code":"4360151-TC","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":905,"maximum":961,"gross_charge":1131,"discounted_cash":848,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961}]}]},{"description":"Ct Pelvis W/o Contrast","code_information":[{"code":"4360143-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72192","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":905,"maximum":961,"gross_charge":1131,"discounted_cash":848,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961}]}]},{"description":"Ct Upper Extremity W/ Contrast Left","code_information":[{"code":"4360401","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905,"maximum":961,"gross_charge":1131,"discounted_cash":848,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961}]}]},{"description":"Ct Upper Extremity W/ Contrast Right","code_information":[{"code":"4360400","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905,"maximum":961,"gross_charge":1131,"discounted_cash":848,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961}]}]},{"description":"Ct Chest W/o Contrast","code_information":[{"code":"4360127-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71250","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":900,"maximum":956,"gross_charge":1125,"discounted_cash":844,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":956},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":956}]}]},{"description":"Ct Spine Lumbar W/o Contrast","code_information":[{"code":"4360136-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72131","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":891,"maximum":947,"gross_charge":1114,"discounted_cash":836,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":947}]}]},{"description":"Ct Spine Thoracic W/o Contrast","code_information":[{"code":"4360137-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72128","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":891,"maximum":947,"gross_charge":1114,"discounted_cash":836,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":947}]}]},{"description":"Respiratory Panel 2.1 (Biofire)","code_information":[{"code":"4400015","type":"CDM"},{"code":"306","type":"RC"},{"code":"87633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":890,"maximum":945,"gross_charge":1112,"discounted_cash":834,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":945}]}]},{"description":"Ct Spine Cervical W/o Contrast","code_information":[{"code":"4360124-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72125","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":886,"maximum":942,"gross_charge":1108,"discounted_cash":831,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":942},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":886},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":886},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":886},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":942}]}]},{"description":"Ct Head Or Brain W/ Contrast","code_information":[{"code":"4360134-TC","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":877,"maximum":932,"gross_charge":1096,"discounted_cash":822,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":932},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":932}]}]},{"description":"Ct Maxillofacial W/ Contrast","code_information":[{"code":"4360156-TC","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":877,"maximum":932,"gross_charge":1096,"discounted_cash":822,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":932},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":932}]}]},{"description":"Ct Soft Tissue Neck W/ Contrast","code_information":[{"code":"4360128-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70491","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":877,"maximum":932,"gross_charge":1096,"discounted_cash":822,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":932},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":932}]}]},{"description":"Cva Device; Nt, < 5 Yrs Charge","code_information":[{"code":"4454042","type":"CDM"},{"code":"450","type":"RC"},{"code":"36555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":866,"maximum":920,"gross_charge":1082,"discounted_cash":812,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":920},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":920}]}]},{"description":"Transport Emerg Bls","code_information":[{"code":"4530006-ET","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0429","type":"HCPCS","modifier":"ET"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ET"],"minimum":855,"maximum":909,"gross_charge":1069,"discounted_cash":802,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":909},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":909}]}]},{"description":"19100 Bx Breast;per Needle Core","code_information":[{"code":"4454040","type":"CDM"},{"code":"761","type":"RC"},{"code":"19100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":854,"maximum":908,"gross_charge":1068,"discounted_cash":801,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":908},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":908}]}]},{"description":"55100 Drain Scrotum Wall Absces","code_information":[{"code":"4453172","type":"CDM"},{"code":"761","type":"RC"},{"code":"55100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":854,"maximum":908,"gross_charge":1068,"discounted_cash":801,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":908},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":908}]}]},{"description":"99284- Ed Visit Level 4 Moderate","code_information":[{"code":"4453004","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":844,"maximum":897,"gross_charge":1055,"discounted_cash":791,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":897},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":897}]}]},{"description":"13152 Rpr Cpx;lid,n,e;2.6-7.5cm","code_information":[{"code":"4453071","type":"CDM"},{"code":"761","type":"RC"},{"code":"13152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":838,"maximum":891,"gross_charge":1048,"discounted_cash":786,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":891}]}]},{"description":"Ct Abdomen W/o Contrast","code_information":[{"code":"4360123-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74150","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":835,"maximum":887,"gross_charge":1044,"discounted_cash":783,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":887},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":835},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":835},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":835},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":887}]}]},{"description":"36430 Blood Transfusion","code_information":[{"code":"4455001","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":827,"maximum":879,"gross_charge":1034,"discounted_cash":776,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":879}]}]},{"description":"25675 Disloc Clsd Rad/uln W Man","code_information":[{"code":"4453980","type":"CDM"},{"code":"761","type":"RC"},{"code":"25675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":811,"maximum":862,"gross_charge":1014,"discounted_cash":761,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"27508 Fx Clsd Med Cond Wo Manip","code_information":[{"code":"4456175","type":"CDM"},{"code":"761","type":"RC"},{"code":"27508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":811,"maximum":862,"gross_charge":1014,"discounted_cash":761,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":862}]}]},{"description":"Fx Clsd Bimal Ankle With Manip Tech","code_information":[{"code":"44527810","type":"CDM"},{"code":"761","type":"RC"},{"code":"27810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":807,"maximum":858,"gross_charge":1009,"discounted_cash":757,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":858},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":858}]}]},{"description":"Ct Lower Extremity W/o Contrast Left","code_information":[{"code":"4360147-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":789,"maximum":838,"gross_charge":986,"discounted_cash":740,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838}]}]},{"description":"Ct Lower Extremity W/o Contrast Right","code_information":[{"code":"4360149-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":789,"maximum":838,"gross_charge":986,"discounted_cash":740,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838}]}]},{"description":"Ct Upper Extremity W/o Contrast Left","code_information":[{"code":"4360148-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":789,"maximum":838,"gross_charge":986,"discounted_cash":740,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838}]}]},{"description":"Ct Upper Extremity W/o Contrast Right","code_information":[{"code":"4360150-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":789,"maximum":838,"gross_charge":986,"discounted_cash":740,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838}]}]},{"description":"25650 Fx Clsd Tx Ulnar Styloid","code_information":[{"code":"4454063","type":"CDM"},{"code":"761","type":"RC"},{"code":"25650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":784,"maximum":833,"gross_charge":980,"discounted_cash":735,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":833},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":833}]}]},{"description":"64634 Destrov C/th Facet Jnt Addl Pain Charge","code_information":[{"code":"49064634","type":"CDM"},{"code":"761","type":"RC"},{"code":"64634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":768,"maximum":816,"gross_charge":960,"discounted_cash":720,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":816},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":816}]}]},{"description":"64636 Destroy 1/s Facet Jnt Addl Pain Charge","code_information":[{"code":"49064636","type":"CDM"},{"code":"761","type":"RC"},{"code":"64636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":768,"maximum":816,"gross_charge":960,"discounted_cash":720,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":816},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":816}]}]},{"description":"10120 Fb Removal; Subq, Simple Ed Tech","code_information":[{"code":"4453013","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":760,"maximum":808,"gross_charge":950,"discounted_cash":713,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808}]}]},{"description":"Sim Rpr S,ax,g 12.6-20cm","code_information":[{"code":"4453031","type":"CDM"},{"code":"450","type":"RC"},{"code":"12005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":760,"maximum":808,"gross_charge":950,"discounted_cash":713,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808}]}]},{"description":"10061 I&d Abscess Cmpl/mltpl","code_information":[{"code":"4453211","type":"CDM"},{"code":"450","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":760,"maximum":808,"gross_charge":950,"discounted_cash":713,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808}]}]},{"description":"12034 Rpr Lay;s,ax,g;7.6-12.5cm","code_information":[{"code":"4453043","type":"CDM"},{"code":"761","type":"RC"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":760,"maximum":808,"gross_charge":950,"discounted_cash":713,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808}]}]},{"description":"12035 Rpr Lay;s,ax,g;12.6-20cm","code_information":[{"code":"4453044","type":"CDM"},{"code":"761","type":"RC"},{"code":"12035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":760,"maximum":808,"gross_charge":950,"discounted_cash":713,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808}]}]},{"description":"36680 Insert Io Needle","code_information":[{"code":"4453156","type":"CDM"},{"code":"761","type":"RC"},{"code":"36680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":759,"maximum":807,"gross_charge":949,"discounted_cash":712,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":759},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":759},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":759},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807}]}]},{"description":"65220 Remove Fb Eye;corneal","code_information":[{"code":"4453178","type":"CDM"},{"code":"761","type":"RC"},{"code":"65220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":759,"maximum":807,"gross_charge":949,"discounted_cash":712,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":759},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":759},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":759},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807}]}]},{"description":"27750 Fx Tib Shft Clsd Wo Manip","code_information":[{"code":"4453116","type":"CDM"},{"code":"761","type":"RC"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":757,"maximum":804,"gross_charge":946,"discounted_cash":710,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":804},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":804}]}]},{"description":"20604 Finger/toe Inj W/i [Cchd]","code_information":[{"code":"49020604","type":"CDM"},{"code":"761","type":"RC"},{"code":"20604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":757,"maximum":804,"gross_charge":946,"discounted_cash":710,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":804},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":804}]}]},{"description":"20611 Major/ Joint Bursa (With Ultrasound) Pain Charge","code_information":[{"code":"49020611","type":"CDM"},{"code":"761","type":"RC"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":757,"maximum":804,"gross_charge":946,"discounted_cash":710,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":804},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":804}]}]},{"description":"64405 Njx Aa&/strd Gr Ocpl Nrv (Gon) Pain Charge","code_information":[{"code":"49064405","type":"CDM"},{"code":"761","type":"RC"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":757,"maximum":804,"gross_charge":946,"discounted_cash":710,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":804},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":804}]}]},{"description":"CT scan","code_information":[{"code":"4360135-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70450","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":756,"maximum":803,"gross_charge":945,"discounted_cash":709,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803}]}]},{"description":"Ct Maxillofacial W/o Contrast","code_information":[{"code":"4360155-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70486","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":756,"maximum":803,"gross_charge":945,"discounted_cash":709,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803}]}]},{"description":"Ct Orbit Sella Etc. W/o Contrast","code_information":[{"code":"4360140-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70480","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":756,"maximum":803,"gross_charge":945,"discounted_cash":709,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803}]}]},{"description":"Ct Sinus W/o Contrast","code_information":[{"code":"4360138-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70486","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":756,"maximum":803,"gross_charge":945,"discounted_cash":709,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803}]}]},{"description":"Ct Soft Tissue Neck W/o Contrast","code_information":[{"code":"4360129-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70490","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":756,"maximum":803,"gross_charge":945,"discounted_cash":709,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803}]}]},{"description":"Rpr Layr Face,ers;>30cm","code_information":[{"code":"4453059","type":"CDM"},{"code":"761","type":"RC"},{"code":"12057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":730,"maximum":776,"gross_charge":913,"discounted_cash":685,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":776},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":776}]}]},{"description":"Aph Rbc Acda As3 Lr Irr","code_information":[{"code":"4393148","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":696,"maximum":740,"gross_charge":870,"discounted_cash":653,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":740},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":740}]}]},{"description":"Aph Rbc Acda As3 Lr Irr 1","code_information":[{"code":"4393149","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":696,"maximum":740,"gross_charge":870,"discounted_cash":653,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":740},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":740}]}]},{"description":"Aph Rbc Acda As3 Lr Irr 2","code_information":[{"code":"4393150","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":696,"maximum":740,"gross_charge":870,"discounted_cash":653,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":740},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":740}]}]},{"description":"Rbc Cpd As1 500 Lr Irr","code_information":[{"code":"4393152","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":696,"maximum":740,"gross_charge":870,"discounted_cash":653,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":740},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":740}]}]},{"description":"64484 Ini Foramen Epidural Add-on Pain Charge","code_information":[{"code":"49064484","type":"CDM"},{"code":"761","type":"RC"},{"code":"64484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":672,"maximum":714,"gross_charge":840,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":714},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":714}]}]},{"description":"64491 Ini Paravert F Jnt  C/t 2 Level Pain Charge","code_information":[{"code":"49064491","type":"CDM"},{"code":"761","type":"RC"},{"code":"64491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":672,"maximum":714,"gross_charge":840,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":714},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":714}]}]},{"description":"64492 Ini Oaravert Jnt C/t 3 Level Pain Charge","code_information":[{"code":"49064492","type":"CDM"},{"code":"761","type":"RC"},{"code":"64492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":672,"maximum":714,"gross_charge":840,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":714},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":714}]}]},{"description":"13132 Rpr Compx;fh,ch;2.6-7.5cm","code_information":[{"code":"4453067","type":"CDM"},{"code":"761","type":"RC"},{"code":"13132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":662,"maximum":704,"gross_charge":828,"discounted_cash":621,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":704},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":704}]}]},{"description":"Rpr Layr Face 20.1-30.0cm","code_information":[{"code":"4453058","type":"CDM"},{"code":"761","type":"RC"},{"code":"12056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":649,"maximum":689,"gross_charge":811,"discounted_cash":608,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":689},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":689}]}]},{"description":"92977 Thrombolysis Coronary Iv","code_information":[{"code":"4453201","type":"CDM"},{"code":"761","type":"RC"},{"code":"92977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":646,"maximum":686,"gross_charge":807,"discounted_cash":605,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":686},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":646},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":646},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":646},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":686}]}]},{"description":"Transport Non Emerg Als1","code_information":[{"code":"4530007","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":642,"maximum":682,"gross_charge":802,"discounted_cash":602,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":682}]}]},{"description":"11421 Bn Exc Les .6-1 Cm Scalp","code_information":[{"code":"4453990","type":"CDM"},{"code":"450","type":"RC"},{"code":"11421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":636,"maximum":676,"gross_charge":795,"discounted_cash":596,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":676}]}]},{"description":"31605 Trach Emerg Cricothyroid","code_information":[{"code":"4454090","type":"CDM"},{"code":"761","type":"RC"},{"code":"31605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":622,"maximum":660,"gross_charge":777,"discounted_cash":583,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":660}]}]},{"description":"25630 Fracture Carpal Clinic Charge","code_information":[{"code":"25630","type":"CDM"},{"code":"521","type":"RC"},{"code":"25630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":605,"maximum":643,"gross_charge":756,"discounted_cash":567,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":643},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":643}]}]},{"description":"11441 Exc Benign Face/ear 0.6-1.0 Cm","code_information":[{"code":"4454041","type":"CDM"},{"code":"450","type":"RC"},{"code":"11441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":602,"maximum":640,"gross_charge":753,"discounted_cash":565,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":640}]}]},{"description":"Removal Fb Foot Subq","code_information":[{"code":"4453122","type":"CDM"},{"code":"450","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":602,"maximum":640,"gross_charge":753,"discounted_cash":565,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":640}]}]},{"description":"MRI Scan","code_information":[{"code":"4320001","type":"CDM"},{"code":"610","type":"RC"},{"code":"70553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":602,"maximum":639,"gross_charge":752,"discounted_cash":564,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":639},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":639}]}]},{"description":"Direct Referral To Observation","code_information":[{"code":"4453265","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":638,"gross_charge":750,"discounted_cash":563,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":638}]}]},{"description":"92950 Cardiopulmonary Resuscitation","code_information":[{"code":"4453186","type":"CDM"},{"code":"450","type":"RC"},{"code":"92950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":598,"maximum":636,"gross_charge":748,"discounted_cash":561,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":636}]}]},{"description":"Pumon Func W Bronchodilation","code_information":[{"code":"4413068","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":598,"maximum":636,"gross_charge":748,"discounted_cash":561,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":636}]}]},{"description":"Us Joint Left","code_information":[{"code":"4351031-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":598,"maximum":635,"gross_charge":747,"discounted_cash":560,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":635},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":635}]}]},{"description":"Us Joint Right","code_information":[{"code":"4351034-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":598,"maximum":635,"gross_charge":747,"discounted_cash":560,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":635},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":635}]}]},{"description":"40831 Rpr Lac >2.5cm Vest Mouth","code_information":[{"code":"4453163","type":"CDM"},{"code":"761","type":"RC"},{"code":"40831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":592,"maximum":629,"gross_charge":740,"discounted_cash":555,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629}]}]},{"description":"21400 Fx Clsd Orbit Wo Manipula","code_information":[{"code":"4453253","type":"CDM"},{"code":"761","type":"RC"},{"code":"21400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":591,"maximum":628,"gross_charge":739,"discounted_cash":554,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":628}]}]},{"description":"41252 Rpr Lac Tng Cpx >2.6cm","code_information":[{"code":"4453166","type":"CDM"},{"code":"761","type":"RC"},{"code":"41252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":591,"maximum":628,"gross_charge":739,"discounted_cash":554,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":628}]}]},{"description":"64615 Chemodenerv  Musc Migraine Pain Charge","code_information":[{"code":"49064615B","type":"CDM"},{"code":"761","type":"RC"},{"code":"64615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":627,"gross_charge":738,"discounted_cash":554,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":627},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":627}]}]},{"description":"64494 Ini Oaravert F Jnt 1/s 2 Level Pain Charge","code_information":[{"code":"49064494","type":"CDM"},{"code":"761","type":"RC"},{"code":"64494","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":576,"maximum":612,"gross_charge":720,"discounted_cash":540,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":612}]}]},{"description":"64495 Ini Paravert F Jnt L/s 3 Level Pain Charge","code_information":[{"code":"49064495","type":"CDM"},{"code":"761","type":"RC"},{"code":"64495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":576,"maximum":612,"gross_charge":720,"discounted_cash":540,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":612}]}]},{"description":"27603 I/d Leg Deep Clinic Charge","code_information":[{"code":"27603","type":"CDM"},{"code":"521","type":"RC"},{"code":"27603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":572,"maximum":608,"gross_charge":715,"discounted_cash":536,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":572},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":572},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":572},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":608}]}]},{"description":"CT scan of abdomen and pelvis with contrast","code_information":[{"code":"4360310","type":"CDM"},{"code":"350","type":"RC"},{"code":"74177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":568,"maximum":604,"gross_charge":710,"discounted_cash":533,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604}]}]},{"description":"12055 Rpr Layr Face 12.6-20.0cm","code_information":[{"code":"4453057","type":"CDM"},{"code":"761","type":"RC"},{"code":"12055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":568,"maximum":604,"gross_charge":710,"discounted_cash":533,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604}]}]},{"description":"20552 Inj Trigger Point 1/2 Muscl-ed Pf","code_information":[{"code":"4454038","type":"CDM"},{"code":"450","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"20550 Injection(s); Single Tendon Sheath, Or Ligament, Aponeurosis","code_information":[{"code":"49020550","type":"CDM"},{"code":"761","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"20552 Trigger Point Injection(1-2 Muscles)(tpi) Pain Charge","code_information":[{"code":"49020552","type":"CDM"},{"code":"761","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"20553 Trigger Pointinjection Point Injects(3+ Muscles) Pain Charge","code_information":[{"code":"49020553","type":"CDM"},{"code":"761","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"20600 Small Joint Pain Charge","code_information":[{"code":"49020600","type":"CDM"},{"code":"761","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"20605 Xyphoid Joint Injection Pain Charge","code_information":[{"code":"49020605","type":"CDM"},{"code":"761","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"20610 Drain/inj  Joint/bursa W/o Us Pain Charge","code_information":[{"code":"49020610","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"64505 Sphenopalatine Ganglion Transnasal Pain Charge","code_information":[{"code":"49064505","type":"CDM"},{"code":"761","type":"RC"},{"code":"64505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"64999 Ganglion Imar [Cchd]","code_information":[{"code":"49064999","type":"CDM"},{"code":"761","type":"RC"},{"code":"64999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"64616 Chemodenervation Neck Muscles Unilateral","code_information":[{"code":"49064616","type":"CDM"},{"code":"761","type":"RC"},{"code":"64616","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":600,"gross_charge":706,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"20526 Ther Injection Carp Tunnel","code_information":[{"code":"49020526","type":"CDM"},{"code":"761","type":"RC"},{"code":"20526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":564,"maximum":599,"gross_charge":705,"discounted_cash":529,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599}]}]},{"description":"J8499 Juvederm Ultra Plus Xc","code_information":[{"code":"CP17667782174468987","type":"CDM"},{"code":"CP17667782174468987","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":560,"maximum":595,"gross_charge":700,"discounted_cash":525,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":595}]}]},{"description":"64421 Inj Interc Nerve Multiple","code_information":[{"code":"4456457","type":"CDM"},{"code":"761","type":"RC"},{"code":"64421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":558,"maximum":593,"gross_charge":698,"discounted_cash":524,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593}]}]},{"description":"64493 Inj Facet Jt Nerv Lum/sac","code_information":[{"code":"4454061","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":558,"maximum":593,"gross_charge":698,"discounted_cash":524,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593}]}]},{"description":"I&d Of Ischiorectal And/or Perirectal Abscesscharge","code_information":[{"code":"46040","type":"CDM"},{"code":"521","type":"RC"},{"code":"46040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":558,"maximum":593,"gross_charge":698,"discounted_cash":524,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593}]}]},{"description":"Dnu","code_information":[{"code":"CP17667781911493228","type":"CDM"},{"code":"CP17667781911493228","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":547,"maximum":581,"gross_charge":684,"discounted_cash":513,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581}]}]},{"description":"Clopidogrel Cyp2c19 Genotype Cvt","code_information":[{"code":"4307000","type":"CDM"},{"code":"310","type":"RC"},{"code":"81225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":546,"maximum":580,"gross_charge":682,"discounted_cash":512,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":580},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":580}]}]},{"description":"99283- Ed Visit Level 3 Intermediate","code_information":[{"code":"4453003","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":544,"maximum":578,"gross_charge":680,"discounted_cash":510,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":544},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":544},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":544},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":578}]}]},{"description":"25535 Fx Uln Shft Clsd W Manipu","code_information":[{"code":"4453096","type":"CDM"},{"code":"761","type":"RC"},{"code":"25535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":541,"maximum":575,"gross_charge":676,"discounted_cash":507,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":575}]}]},{"description":"Transport Non Emerg Bls","code_information":[{"code":"4530005","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":534,"maximum":568,"gross_charge":668,"discounted_cash":501,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":568}]}]},{"description":"Aph Rbc Acda As3 Lr","code_information":[{"code":"4393145","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":529,"maximum":562,"gross_charge":661,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562}]}]},{"description":"Aph Rbc Acda As3 Lr 1","code_information":[{"code":"4393146","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":529,"maximum":562,"gross_charge":661,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562}]}]},{"description":"Aph Rbc Acda As3 Lr 2","code_information":[{"code":"4393147","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":529,"maximum":562,"gross_charge":661,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562}]}]},{"description":"Rbc Cpd As1 500 Lr","code_information":[{"code":"4393151","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":529,"maximum":562,"gross_charge":661,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562}]}]},{"description":"99496 Transitional Care Mgnt, High Complexity Decision Making, Ftof Visit Within 7d Of Discharge","code_information":[{"code":"99496","type":"CDM"},{"code":"521","type":"RC"},{"code":"99496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":529,"maximum":562,"gross_charge":661,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562}]}]},{"description":"11043 Debrid Mscl &Or Fsc 1st20","code_information":[{"code":"4453021","type":"CDM"},{"code":"761","type":"RC"},{"code":"11043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":527,"maximum":560,"gross_charge":659,"discounted_cash":494,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560}]}]},{"description":"25622 Fx Navic Clsd Wo Manipula","code_information":[{"code":"4453100","type":"CDM"},{"code":"761","type":"RC"},{"code":"25622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":527,"maximum":560,"gross_charge":659,"discounted_cash":494,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560}]}]},{"description":"25630 Fx Navic Clsd Wo Man Each","code_information":[{"code":"4453101","type":"CDM"},{"code":"761","type":"RC"},{"code":"25630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":527,"maximum":560,"gross_charge":659,"discounted_cash":494,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560}]}]},{"description":"27250 Dscl Hip Traum Clsd Wo An","code_information":[{"code":"4454045","type":"CDM"},{"code":"761","type":"RC"},{"code":"27250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":527,"maximum":560,"gross_charge":659,"discounted_cash":494,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560}]}]},{"description":"Gi Panel B (Immunocompetent) Filmarray","code_information":[{"code":"43087506","type":"CDM"},{"code":"306","type":"RC"},{"code":"87506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":526,"maximum":558,"gross_charge":657,"discounted_cash":493,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558}]}]},{"description":"36430 Blood Administration 1 Unit","code_information":[{"code":"CP17667781911235316","type":"CDM"},{"code":"CP17667781911235316","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":525,"maximum":558,"gross_charge":656,"discounted_cash":492,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558}]}]},{"description":"90679, Arexvy, Medical Center Of Dimmitt","code_information":[{"code":"90679","type":"CDM"},{"code":"636","type":"RC"},{"code":"90679","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":515,"maximum":547,"gross_charge":644,"discounted_cash":483,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":547}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"12020 Closure Of Split Wound; Simple- Prof Chg","code_information":[{"code":"4456091","type":"CDM"},{"code":"450","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":514,"maximum":546,"gross_charge":642,"discounted_cash":482,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546}]}]},{"description":"Debride Infected Skin^10%","code_information":[{"code":"4453016","type":"CDM"},{"code":"450","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":514,"maximum":546,"gross_charge":642,"discounted_cash":482,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546}]}]},{"description":"12044 Rpr Lay;n,h,ft;7.6-12.5cm","code_information":[{"code":"4453049","type":"CDM"},{"code":"761","type":"RC"},{"code":"12044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":514,"maximum":546,"gross_charge":642,"discounted_cash":482,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546}]}]},{"description":"13100 Repr,compx,trnk 1.1-2.5cm","code_information":[{"code":"4453060","type":"CDM"},{"code":"761","type":"RC"},{"code":"13100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":514,"maximum":546,"gross_charge":642,"discounted_cash":482,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546}]}]},{"description":"13101 Repr,compx,trnk;2.6-7.5cm","code_information":[{"code":"4453061","type":"CDM"},{"code":"761","type":"RC"},{"code":"13101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":514,"maximum":546,"gross_charge":642,"discounted_cash":482,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546}]}]},{"description":"13120 Rpr Compx;sc,ex;1.1-2.5cm","code_information":[{"code":"4453063","type":"CDM"},{"code":"761","type":"RC"},{"code":"13120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":514,"maximum":546,"gross_charge":642,"discounted_cash":482,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546}]}]},{"description":"29700 Rem/bival Cast Boot/body","code_information":[{"code":"44529700","type":"CDM"},{"code":"450","type":"RC"},{"code":"29700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":512,"maximum":544,"gross_charge":640,"discounted_cash":480,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":544},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":544}]}]},{"description":"Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit","code_information":[{"code":"4393157","type":"CDM"},{"code":"381","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":505,"maximum":536,"gross_charge":631,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":536}]}]},{"description":"Us Breast Left Complete","code_information":[{"code":"4351004-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":504,"maximum":536,"gross_charge":630,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":536}]}]},{"description":"Us Breast Right Complete","code_information":[{"code":"4351032-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":504,"maximum":536,"gross_charge":630,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":536}]}]},{"description":"Tube Dignishield Stool Management","code_information":[{"code":"4273006","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":502,"maximum":534,"gross_charge":628,"discounted_cash":471,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":534}]}]},{"description":"Injection Procedure Only For Mammary Ductogram Or Galactogra","code_information":[{"code":"4453970","type":"CDM"},{"code":"761","type":"RC"},{"code":"13151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":500,"maximum":531,"gross_charge":625,"discounted_cash":469,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531}]}]},{"description":"Rpr Lay;h,n,ft;20.1-30cm","code_information":[{"code":"4453051","type":"CDM"},{"code":"761","type":"RC"},{"code":"12046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":500,"maximum":531,"gross_charge":625,"discounted_cash":469,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531}]}]},{"description":"Room/bed: Special Equipment","code_information":[{"code":"3110009","type":"CDM"},{"code":"121","type":"RC"},{"code":"CP3110009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":492,"maximum":523,"gross_charge":615,"discounted_cash":461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523}]}]},{"description":"90651 Human Papilloma Virus 9- Valent Vaccine","code_information":[{"code":"90651","type":"CDM"},{"code":"636","type":"RC"},{"code":"90651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":491,"maximum":522,"gross_charge":614,"discounted_cash":461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":522}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"12054 Rpr Layr Face 7.6-12.5cm","code_information":[{"code":"4453056","type":"CDM"},{"code":"761","type":"RC"},{"code":"12054","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":517,"gross_charge":608,"discounted_cash":456,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517}]}]},{"description":"25530 Clsd Tx Ul Shaf Fx W/oman","code_information":[{"code":"4453095","type":"CDM"},{"code":"761","type":"RC"},{"code":"25530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":517,"gross_charge":608,"discounted_cash":456,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517}]}]},{"description":"40650 Repair Lip Vermillion Onl","code_information":[{"code":"4453161","type":"CDM"},{"code":"761","type":"RC"},{"code":"40650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":517,"gross_charge":608,"discounted_cash":456,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517}]}]},{"description":"43450 Dilation Esophagus Bougie","code_information":[{"code":"4454070","type":"CDM"},{"code":"761","type":"RC"},{"code":"43450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":514,"gross_charge":605,"discounted_cash":454,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514}]}]},{"description":"21450 Fx Clsd Mandible Wo Manip","code_information":[{"code":"4456491","type":"CDM"},{"code":"761","type":"RC"},{"code":"21450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":514,"gross_charge":605,"discounted_cash":454,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514}]}]},{"description":"22310 Fx Clsd Vert Body Wo Mani","code_information":[{"code":"4456456","type":"CDM"},{"code":"761","type":"RC"},{"code":"22310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":474,"maximum":503,"gross_charge":592,"discounted_cash":444,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Sim Rpr Face,ers >30cm","code_information":[{"code":"4453040","type":"CDM"},{"code":"761","type":"RC"},{"code":"12018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":474,"maximum":503,"gross_charge":592,"discounted_cash":444,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"51700 Bladder Irrigation, Simple, Lavage And/or Instillation","code_information":[{"code":"44551700","type":"CDM"},{"code":"450","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":471,"maximum":501,"gross_charge":589,"discounted_cash":442,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501}]}]},{"description":"54220 Irrigation For Priapism","code_information":[{"code":"44554220","type":"CDM"},{"code":"450","type":"RC"},{"code":"54220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":471,"maximum":501,"gross_charge":589,"discounted_cash":442,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501}]}]},{"description":"54450 Manipul Foreskin Adh Stre","code_information":[{"code":"44554450","type":"CDM"},{"code":"450","type":"RC"},{"code":"54450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":471,"maximum":501,"gross_charge":589,"discounted_cash":442,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501}]}]},{"description":"Hepatitis C Viral Rna Genotype Cvt","code_information":[{"code":"4302270","type":"CDM"},{"code":"306","type":"RC"},{"code":"87902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":469,"maximum":498,"gross_charge":586,"discounted_cash":440,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":498}]}]},{"description":"Dup-scan Xtr Veins Complete Bilateral Study","code_information":[{"code":"4430415-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":467,"maximum":496,"gross_charge":584,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496}]}]},{"description":"Us Aorta Duplex Complete","code_information":[{"code":"4430102-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93978","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":467,"maximum":496,"gross_charge":584,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496}]}]},{"description":"Us Art/vein Abd/pelvis/scrotal Complete","code_information":[{"code":"4430103-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93975","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":467,"maximum":496,"gross_charge":584,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496}]}]},{"description":"Us Carotid Doppler Bilateral","code_information":[{"code":"4430116-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":467,"maximum":496,"gross_charge":584,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496}]}]},{"description":"Us Le Arterial Duplex Bilateral","code_information":[{"code":"4430107-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93925","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":467,"maximum":496,"gross_charge":584,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496}]}]},{"description":"Us Le Venous Duplex Bilateral","code_information":[{"code":"4430400-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":467,"maximum":496,"gross_charge":584,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496}]}]},{"description":"Er Intubation","code_information":[{"code":"4453151","type":"CDM"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":466,"maximum":495,"gross_charge":582,"discounted_cash":437,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":495}]}]},{"description":"Picc Line Antimicrobial","code_information":[{"code":"4273941","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":465,"maximum":494,"gross_charge":581,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":494},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":494}]}]},{"description":"46050 I&d Peri Anal Abcsess,sup","code_information":[{"code":"4453168","type":"CDM"},{"code":"761","type":"RC"},{"code":"46050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":462,"maximum":490,"gross_charge":577,"discounted_cash":433,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":490}]}]},{"description":"12036 Rpr Lay;s,ax,g;20.1-30cm","code_information":[{"code":"4453045","type":"CDM"},{"code":"761","type":"RC"},{"code":"12036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":460,"maximum":489,"gross_charge":575,"discounted_cash":431,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":489}]}]},{"description":"23525 Closed Treatment Of Sternoclavicular Dislocation; With Manip[cchd]","code_information":[{"code":"44523525","type":"CDM"},{"code":"450","type":"RC"},{"code":"23525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"25600 Closed Treatment Of Distal Radial Fracture","code_information":[{"code":"4453098","type":"CDM"},{"code":"450","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"Fx Phal Shft Prox Clsd Wo","code_information":[{"code":"4453109","type":"CDM"},{"code":"450","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"Fx Toe Clsd Wo Manip Each","code_information":[{"code":"4453130","type":"CDM"},{"code":"450","type":"RC"},{"code":"28510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"23650 Dslc Shoulder Clsd Wo Ane","code_information":[{"code":"4453086","type":"CDM"},{"code":"761","type":"RC"},{"code":"23650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"24640 Sublxtn Rad He Child Clsd","code_information":[{"code":"4453090","type":"CDM"},{"code":"761","type":"RC"},{"code":"24640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"26725 Fx Phal Shft Prox Clsd Wm","code_information":[{"code":"4453110","type":"CDM"},{"code":"761","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"27824 Fx Dis Tib Clsd Wo Manip","code_information":[{"code":"44527824","type":"CDM"},{"code":"450","type":"RC"},{"code":"27824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"27840 Closed Treatment Of Ankle Dislocation; Without Anesthesia.","code_information":[{"code":"44527840","type":"CDM"},{"code":"761","type":"RC"},{"code":"27840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"28630 Disloc Clsd Tx Mtp Jt Wo","code_information":[{"code":"4456195","type":"CDM"},{"code":"761","type":"RC"},{"code":"28630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":478,"gross_charge":562,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}]},{"description":"Room/bed: Private","code_information":[{"code":"3110010","type":"CDM"},{"code":"111","type":"RC"},{"code":"CP3110010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":440,"maximum":468,"gross_charge":550,"discounted_cash":413,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Room/bed: Semi Private","code_information":[{"code":"3110005","type":"CDM"},{"code":"121","type":"RC"},{"code":"CP3110005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":440,"maximum":468,"gross_charge":550,"discounted_cash":413,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468}]}]},{"description":"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm Technical Charge","code_information":[{"code":"21930","type":"CDM"},{"code":"521","type":"RC"},{"code":"21930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":434,"maximum":462,"gross_charge":543,"discounted_cash":407,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462}]}]},{"description":"Md Closed Treatment Of Femoral Fx W/o Manipulation","code_information":[{"code":"25600","type":"CDM"},{"code":"521","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":434,"maximum":462,"gross_charge":543,"discounted_cash":407,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462}]}]},{"description":"Fx Rad Uln Shft Clsd Woma","code_information":[{"code":"4453097","type":"CDM"},{"code":"450","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":460,"gross_charge":541,"discounted_cash":406,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"12045 Rpr Lay;n,h,ft;12.6-20cm","code_information":[{"code":"4453050","type":"CDM"},{"code":"761","type":"RC"},{"code":"12045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":460,"gross_charge":541,"discounted_cash":406,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis,","code_information":[{"code":"4453027","type":"CDM"},{"code":"761","type":"RC"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":460,"gross_charge":541,"discounted_cash":406,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Abdomial ultrasound of pregnant uterus","code_information":[{"code":"4351005-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":432,"maximum":459,"gross_charge":540,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459}]}]},{"description":"Us Pregnancy Transvaginal","code_information":[{"code":"4351026-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":432,"maximum":459,"gross_charge":540,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459}]}]},{"description":"CT scan of pelvis with contrast","code_information":[{"code":"4360144","type":"CDM"},{"code":"350","type":"RC"},{"code":"72193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":426,"maximum":452,"gross_charge":532,"discounted_cash":399,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452}]}]},{"description":"Closed Trtmt Of Radial & Ulnar Shaft Fxs; W/o Manipulation Charge","code_information":[{"code":"25560","type":"CDM"},{"code":"521","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":448,"gross_charge":527,"discounted_cash":395,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":448},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":448}]}]},{"description":"Critical Care 30-74 Minutes.","code_information":[{"code":"99291-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99291","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":420,"maximum":446,"gross_charge":525,"discounted_cash":394,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446}]}]},{"description":"Sim Rpr Face,ers12.6-30cm","code_information":[{"code":"4453039","type":"CDM"},{"code":"761","type":"RC"},{"code":"12017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":419,"maximum":445,"gross_charge":524,"discounted_cash":393,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445}]}]},{"description":"Ultrasound pelvis through vagina","code_information":[{"code":"4351012","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":410,"maximum":436,"gross_charge":513,"discounted_cash":385,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436}]}]},{"description":"Us Pregnancy Multi Gest > 14 Weeks","code_information":[{"code":"4351007-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":410,"maximum":436,"gross_charge":513,"discounted_cash":385,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436}]}]},{"description":"Ultrasound pelvis through vagina","code_information":[{"code":"4351012-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":410,"maximum":436,"gross_charge":513,"discounted_cash":385,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436}]}]},{"description":"96360hydration, First Hour- Hosp","code_information":[{"code":"4455080","type":"CDM"},{"code":"761","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":434,"gross_charge":511,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}]},{"description":"96365 Iv Infusion Therapy, Prophylaxis /Dx 1st To 1 Hr","code_information":[{"code":"4455082","type":"CDM"},{"code":"761","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":434,"gross_charge":511,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}]},{"description":"96374iv Push, Single Or Initial- Hosp","code_information":[{"code":"4455087","type":"CDM"},{"code":"761","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":434,"gross_charge":511,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}]},{"description":"Inj Ivp Single/init Drug","code_information":[{"code":"4475087","type":"CDM"},{"code":"761","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":434,"gross_charge":511,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}]},{"description":"Iv Infus Hydrate 31-60min","code_information":[{"code":"4475080","type":"CDM"},{"code":"761","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":434,"gross_charge":511,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}]},{"description":"Iv Infus Therapy 1st Hour","code_information":[{"code":"4475082","type":"CDM"},{"code":"761","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":434,"gross_charge":511,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}]},{"description":"Aerosol Subsequent","code_information":[{"code":"4413004","type":"CDM"},{"code":"412","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":432,"gross_charge":508,"discounted_cash":381,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Hhn Set Up And Treatment","code_information":[{"code":"4413006","type":"CDM"},{"code":"412","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":432,"gross_charge":508,"discounted_cash":381,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Fx Dist Fib Clsd Wo Manip","code_information":[{"code":"4453119","type":"CDM"},{"code":"450","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":431,"gross_charge":507,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}]},{"description":"Fx Tib Prox Clsd Wo Manip","code_information":[{"code":"4453115","type":"CDM"},{"code":"450","type":"RC"},{"code":"27530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":431,"gross_charge":507,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}]},{"description":"12007 Sim Rpr S,ax,g,t,ex >30cm","code_information":[{"code":"4453033","type":"CDM"},{"code":"761","type":"RC"},{"code":"12007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":431,"gross_charge":507,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}]},{"description":"12053 Rpr Layr Face 5.1-7.5cm","code_information":[{"code":"4453055","type":"CDM"},{"code":"761","type":"RC"},{"code":"12053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":431,"gross_charge":507,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}]},{"description":"27220 Fx Clsd Acetabulum","code_information":[{"code":"4454064","type":"CDM"},{"code":"761","type":"RC"},{"code":"27220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":431,"gross_charge":507,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}]},{"description":"27808 Fx Bi Ankle Clsd Wo Manip","code_information":[{"code":"4453120","type":"CDM"},{"code":"761","type":"RC"},{"code":"27808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":431,"gross_charge":507,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}]},{"description":"27816 Fx Tri Ankle Clsd Wo Mani","code_information":[{"code":"4453121","type":"CDM"},{"code":"761","type":"RC"},{"code":"27816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":431,"gross_charge":507,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}]},{"description":"Fx Clsd Carpal Scaphoid W/o Manip","code_information":[{"code":"25622","type":"CDM"},{"code":"521","type":"RC"},{"code":"25622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":431,"gross_charge":507,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}]},{"description":"Us Retroperitoneal Complete","code_information":[{"code":"4351013-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":403,"maximum":428,"gross_charge":504,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428}]}]},{"description":"Ultrasound of abdomen","code_information":[{"code":"4351001-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":396,"maximum":421,"gross_charge":495,"discounted_cash":371,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":421}]}]},{"description":"Us Pregnancy < 14 Weeks","code_information":[{"code":"4351020-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":396,"maximum":421,"gross_charge":495,"discounted_cash":371,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":421}]}]},{"description":"Tray Cricothy/trach Adult","code_information":[{"code":"4273382","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273382","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":395,"maximum":420,"gross_charge":494,"discounted_cash":371,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420}]}]},{"description":"Tray Cricothy/trach Pedi","code_information":[{"code":"4273380","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":395,"maximum":420,"gross_charge":494,"discounted_cash":371,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420}]}]},{"description":"27520 Closed Trtmt Of Patellar Fx, W/o Manipulation","code_information":[{"code":"4457131","type":"CDM"},{"code":"450","type":"RC"},{"code":"27520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":392,"maximum":417,"gross_charge":490,"discounted_cash":368,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417}]}]},{"description":"Fx Clavicular Clsd Wo Man","code_information":[{"code":"4453083","type":"CDM"},{"code":"450","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":392,"maximum":417,"gross_charge":490,"discounted_cash":368,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417}]}]},{"description":"13131 Rpr Compx;fh,ch;1.1-2.5cm","code_information":[{"code":"4453066","type":"CDM"},{"code":"761","type":"RC"},{"code":"13131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":392,"maximum":417,"gross_charge":490,"discounted_cash":368,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417}]}]},{"description":"30905 Init Contr Post Nosebleed","code_information":[{"code":"4453149","type":"CDM"},{"code":"761","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":392,"maximum":417,"gross_charge":490,"discounted_cash":368,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417}]}]},{"description":"99495 Transitional Care Mgnt,moderate Complexity Decision Making. Ftof Visit Within 14d Of Discharge","code_information":[{"code":"99495","type":"CDM"},{"code":"521","type":"RC"},{"code":"99495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":390,"maximum":415,"gross_charge":488,"discounted_cash":366,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":415}]}]},{"description":"90710 Proquad Mmr Private","code_information":[{"code":"90710","type":"CDM"},{"code":"636","type":"RC"},{"code":"90710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":386,"maximum":411,"gross_charge":483,"discounted_cash":362,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":411}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Excise, Malign Lesion W/margins, Face, Ears, Eyelids, Nose, Lips; Excised Diam 0.6 To 1.0 Cm  Charge","code_information":[{"code":"11641","type":"CDM"},{"code":"521","type":"RC"},{"code":"11641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":385,"maximum":409,"gross_charge":481,"discounted_cash":361,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"4320007","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":383,"maximum":407,"gross_charge":479,"discounted_cash":359,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"4320082","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":383,"maximum":407,"gross_charge":479,"discounted_cash":359,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"4320083","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":383,"maximum":407,"gross_charge":479,"discounted_cash":359,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407}]}]},{"description":"23500 Closed Trtmt Of Clavicular Fx; W/o Manipulation Charge","code_information":[{"code":"23500","type":"CDM"},{"code":"521","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"10060 Drainage Of Skin Abscess Ed Charge","code_information":[{"code":"4453012","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"12001 Proc Wound Repair 12001 Ed Charge","code_information":[{"code":"4453028","type":"CDM"},{"code":"450","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"12002 Proc Wound Repair 12002 Ed Charge","code_information":[{"code":"4453029","type":"CDM"},{"code":"450","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"12004 Proc Wound Repair 12004 Pro Ed Charge","code_information":[{"code":"4453030","type":"CDM"},{"code":"450","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"12011","code_information":[{"code":"4453034","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"12013 Lac Simple Face/ear 2.6-5.0 Cm Ed Charge","code_information":[{"code":"4454035","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"12014 Proc Wound Repair 12014 Ed Charge","code_information":[{"code":"4453036","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"16000 Burn Treatment Ed Charge","code_information":[{"code":"4453074","type":"CDM"},{"code":"450","type":"RC"},{"code":"16000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"16020","code_information":[{"code":"4453075","type":"CDM"},{"code":"450","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"Avul Nail Plte Smpl Singl","code_information":[{"code":"4453023","type":"CDM"},{"code":"450","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"12015 Sim Rpr Face,er 7.6-12.5c","code_information":[{"code":"4453037","type":"CDM"},{"code":"761","type":"RC"},{"code":"12015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"11102tangential Biopsy Of Skin; Single Lesions","code_information":[{"code":"11102","type":"CDM"},{"code":"521","type":"RC"},{"code":"11102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":405,"gross_charge":477,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405}]}]},{"description":"57180 Intro Hemostatic Vag Hemo","code_information":[{"code":"44557180","type":"CDM"},{"code":"450","type":"RC"},{"code":"57180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":380,"maximum":404,"gross_charge":475,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404}]}]},{"description":"26740 Fx Clsd Tx Join W/o Manip","code_information":[{"code":"4453251","type":"CDM"},{"code":"761","type":"RC"},{"code":"26740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379,"maximum":403,"gross_charge":474,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403}]}]},{"description":"24600 Dslc Elbow Clsd Wo Anesth","code_information":[{"code":"4453088","type":"CDM"},{"code":"761","type":"RC"},{"code":"24600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":378,"maximum":402,"gross_charge":473,"discounted_cash":355,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"26605 Fx Mtcrpl Clsd Sgl Wma Ea","code_information":[{"code":"4453103","type":"CDM"},{"code":"761","type":"RC"},{"code":"26605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":378,"maximum":402,"gross_charge":473,"discounted_cash":355,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"28475 Fx Metatrsl Clsd W Man Ea","code_information":[{"code":"4453127","type":"CDM"},{"code":"761","type":"RC"},{"code":"28475","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":378,"maximum":402,"gross_charge":473,"discounted_cash":355,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Us Ankle Brachial Index","code_information":[{"code":"4430106-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Art/vein Abd/pelvis/scrotal Limited","code_information":[{"code":"4430110-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93976","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Le Venous Duplex Left","code_information":[{"code":"4430401-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Le Venous Duplex Right","code_information":[{"code":"4430416-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Lower Extremity Arterial Duplex Left","code_information":[{"code":"4430405-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Lower Extremity Arterial Duplex Right","code_information":[{"code":"4430419-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Segmental Pressures Upper Multi","code_information":[{"code":"4430104-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93923","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Segmental Pressures Upper Single","code_information":[{"code":"4430105-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Ue Arterial Duplex Bilateral","code_information":[{"code":"4430108-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93930","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Ue Venous Duplex Left Dup-scan Xtr Veins Unilateral/limited Study","code_information":[{"code":"4430417-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Ue Venous Duplex Right Dup-scan Xtr Veins Unilateral/limited Study","code_information":[{"code":"4430418-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Upper Exremity Arterial Duplex Left","code_information":[{"code":"4430109-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Upper Extremity Arterial Duplex Right","code_information":[{"code":"4430413-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Boot Ankle Walkr Med","code_information":[{"code":"4273243","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Boot Ankle Walkr Xlg","code_information":[{"code":"4273633","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Boot Hi-top Med Walker","code_information":[{"code":"4273687","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Boot Hi-top Xl Walker","code_information":[{"code":"4273701","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273701","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"L4387- Boot Hi-top Lg Walker [Cchd]","code_information":[{"code":"4273688","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273688","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":375,"maximum":399,"gross_charge":469,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"25530 Fracture Ulnar Shaft Clinic Charge","code_information":[{"code":"25530","type":"CDM"},{"code":"521","type":"RC"},{"code":"25530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":374,"maximum":398,"gross_charge":468,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":398}]}]},{"description":"97167 Ot High Complexity Eval Charge","code_information":[{"code":"4409022","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":394,"gross_charge":464,"discounted_cash":348,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394}]}]},{"description":"Ot Evaluation High Complexity","code_information":[{"code":"4400001","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":394,"gross_charge":464,"discounted_cash":348,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394}]}]},{"description":"Pt Evaluationhigh Complex Bce","code_information":[{"code":"4423022","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":394,"gross_charge":464,"discounted_cash":348,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394}]}]},{"description":"Pt Eval High Complexity 45 Mins Charge","code_information":[{"code":"4429021","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":394,"gross_charge":464,"discounted_cash":348,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394}]}]},{"description":"Fibrin Degradation Product Cvt","code_information":[{"code":"4302345","type":"CDM"},{"code":"305","type":"RC"},{"code":"85362","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":370,"maximum":394,"gross_charge":463,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394}]}]},{"description":"Speech Sound Prod W/ Languarge Chargespeech Sound Prod W/ Language Charge","code_information":[{"code":"4380013","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":370,"maximum":394,"gross_charge":463,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394}]}]},{"description":"27760 Fx Med Malle Clsd Wo Mani","code_information":[{"code":"4453117","type":"CDM"},{"code":"761","type":"RC"},{"code":"27760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":365,"maximum":388,"gross_charge":456,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388}]}]},{"description":"28430 Fx Talus Clsd Wo Manipula","code_information":[{"code":"4453124","type":"CDM"},{"code":"761","type":"RC"},{"code":"28430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":365,"maximum":388,"gross_charge":456,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388}]}]},{"description":"Sim Rpr Face,ers12.6-20cm","code_information":[{"code":"4453038","type":"CDM"},{"code":"761","type":"RC"},{"code":"12016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":365,"maximum":388,"gross_charge":456,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388}]}]},{"description":"Exc, Benign Lesion, Face, Ears, Eyelids, Nose, Lips, Mm; >4.0 Cm Technical Charge","code_information":[{"code":"11446","type":"CDM"},{"code":"521","type":"RC"},{"code":"11446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":364,"maximum":387,"gross_charge":455,"discounted_cash":341,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":387}]}]},{"description":"Tracheostomy Quicktrach  4.0mm","code_information":[{"code":"4273034","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":362,"maximum":385,"gross_charge":453,"discounted_cash":340,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385}]}]},{"description":"MRI scan of lower spinal canal","code_information":[{"code":"4320004","type":"CDM"},{"code":"610","type":"RC"},{"code":"72148","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":361,"maximum":383,"gross_charge":451,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383}]}]},{"description":"Us Pelvic Complete","code_information":[{"code":"4351011-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":360,"maximum":383,"gross_charge":450,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383}]}]},{"description":"Us Pelvic Non Obstetric","code_information":[{"code":"4351011","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":360,"maximum":383,"gross_charge":450,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383}]}]},{"description":"Xr Fluoro Ivp","code_information":[{"code":"4330249-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":360,"maximum":383,"gross_charge":450,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383}]}]},{"description":"Ct Angio Arterial Lower Extremity Left","code_information":[{"code":"4360404-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73706","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":356,"maximum":378,"gross_charge":445,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}]},{"description":"Ct Angio Arterial Lower Extremity Right","code_information":[{"code":"4360403-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73706","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":356,"maximum":378,"gross_charge":445,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}]},{"description":"Ct Angio Venous Lower Extremity Left","code_information":[{"code":"4360406-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73706","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":356,"maximum":378,"gross_charge":445,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}]},{"description":"Ct Angio Venous Lower Extremity Right","code_information":[{"code":"4360045-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73706","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":356,"maximum":378,"gross_charge":445,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}]},{"description":"27246 Fx Clsd Gr Trochan Wo Man","code_information":[{"code":"4457130","type":"CDM"},{"code":"761","type":"RC"},{"code":"27246","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":352,"maximum":374,"gross_charge":440,"discounted_cash":330,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374}]}]},{"description":"90620 Meningococcal Group B Private 0.5 Mg","code_information":[{"code":"90620","type":"CDM"},{"code":"636","type":"RC"},{"code":"90620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":352,"maximum":374,"gross_charge":440,"discounted_cash":330,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Fx Heel Clsd Wo Manipulat","code_information":[{"code":"4453123","type":"CDM"},{"code":"450","type":"RC"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":373,"gross_charge":439,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373}]}]},{"description":"12006 Sim Rpr S,ax,g 20.1-30cm","code_information":[{"code":"4453032","type":"CDM"},{"code":"761","type":"RC"},{"code":"12006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":373,"gross_charge":439,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373}]}]},{"description":"27560 Dslc Patella Clsd Wo Anes","code_information":[{"code":"4453204","type":"CDM"},{"code":"761","type":"RC"},{"code":"27560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":373,"gross_charge":439,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373}]}]},{"description":"28450 Fx Tar Bone Clsd Wo Manip","code_information":[{"code":"4453125","type":"CDM"},{"code":"761","type":"RC"},{"code":"28450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":373,"gross_charge":439,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373}]}]},{"description":"56405 I&d Vulva/perineum Abcess","code_information":[{"code":"4453173","type":"CDM"},{"code":"761","type":"RC"},{"code":"56405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":373,"gross_charge":439,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373}]}]},{"description":"62270 Spinal Tap,lumbar;diagnos","code_information":[{"code":"4453175","type":"CDM"},{"code":"450","type":"RC"},{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":373,"gross_charge":439,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373}]}]},{"description":"65210 Remove Fb Eye;conjun/scle","code_information":[{"code":"4453177","type":"CDM"},{"code":"761","type":"RC"},{"code":"65210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":347,"maximum":369,"gross_charge":434,"discounted_cash":326,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369}]}]},{"description":"13102 Rpr;compxk,trnk;addl 5cm","code_information":[{"code":"4453062","type":"CDM"},{"code":"761","type":"RC"},{"code":"13102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":344,"maximum":366,"gross_charge":430,"discounted_cash":323,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366}]}]},{"description":"Removal Of Nail Bed.","code_information":[{"code":"11750","type":"CDM"},{"code":"521","type":"RC"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":343,"maximum":365,"gross_charge":429,"discounted_cash":322,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365}]}]},{"description":"H1n1 Pcr Cvt","code_information":[{"code":"4302012","type":"CDM"},{"code":"306","type":"RC"},{"code":"87501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":342,"maximum":363,"gross_charge":427,"discounted_cash":320,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363}]}]},{"description":"Us Biophysical Profile","code_information":[{"code":"4351015-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":338,"maximum":360,"gross_charge":423,"discounted_cash":317,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360}]}]},{"description":"59414 Delivery Of Plcnta Sep Pr","code_information":[{"code":"4453202","type":"CDM"},{"code":"450","type":"RC"},{"code":"59414","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":359,"gross_charge":422,"discounted_cash":317,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":359}]}]},{"description":"Closed Trtmt Of Distal Phalangeal Fx, Finger Or Thumb; W/manipulation, Each Charge","code_information":[{"code":"26755","type":"CDM"},{"code":"521","type":"RC"},{"code":"26755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":357,"gross_charge":420,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":357}]}]},{"description":"92953 Temporary External Pacing.","code_information":[{"code":"4453187","type":"CDM"},{"code":"761","type":"RC"},{"code":"92953","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":333,"maximum":354,"gross_charge":416,"discounted_cash":312,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354}]}]},{"description":"11426 Remove Lesion, Scalp/neck/hand/foot >4.0 Cm Charge","code_information":[{"code":"11426","type":"CDM"},{"code":"521","type":"RC"},{"code":"11426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":333,"maximum":354,"gross_charge":416,"discounted_cash":312,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354}]}]},{"description":"Remove Other Benign Lesion W/margins , Face/ears/eyelids/nose/lips; Diam 3.1 To 4.0 Cm Charge","code_information":[{"code":"11444","type":"CDM"},{"code":"521","type":"RC"},{"code":"11444","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":333,"maximum":354,"gross_charge":416,"discounted_cash":312,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354}]}]},{"description":"99236 Same Day Admit Disch Iii Charge","code_information":[{"code":"4447117-AQ","type":"CDM"},{"code":"99236","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":328,"maximum":349,"gross_charge":410,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}]},{"description":"99292 Critical Care, Each 30 Min","code_information":[{"code":"4453010","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":328,"maximum":349,"gross_charge":410,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}]},{"description":"26770 Closed Trtmt Of Interphalang Joint Dislocation, Single, W/manipulation; W/o Anesthesia Charge","code_information":[{"code":"26770","type":"CDM"},{"code":"521","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":328,"maximum":349,"gross_charge":410,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}]},{"description":"Bk Vir Dna Quant Rt Pcr, Ur Cvt","code_information":[{"code":"4302521","type":"CDM"},{"code":"306","type":"RC"},{"code":"87799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":327,"maximum":348,"gross_charge":409,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348}]}]},{"description":"Bk Vir Dna Rt-pcr Cvt","code_information":[{"code":"4302520","type":"CDM"},{"code":"306","type":"RC"},{"code":"87799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":327,"maximum":348,"gross_charge":409,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348}]}]},{"description":"12031 Rpr Layer S,ax,t,ex<2.5cm","code_information":[{"code":"4453041","type":"CDM"},{"code":"761","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":327,"maximum":348,"gross_charge":409,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348}]}]},{"description":"Punctr Asp Absc Hmta Cyst","code_information":[{"code":"4453015","type":"CDM"},{"code":"450","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":327,"maximum":348,"gross_charge":409,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348}]}]},{"description":"Computer Xm Interp","code_information":[{"code":"3003829","type":"CDM"},{"code":"302","type":"RC"},{"code":"86923","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"X-match Is Interp","code_information":[{"code":"4300271","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Jo-1 Antibody Cvt","code_information":[{"code":"4302679","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Rnp Antibody Cvt","code_information":[{"code":"4302673","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Ss-a/ro Antibody Cvt","code_information":[{"code":"4302668","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Ss-b/la Antibody Cvt","code_information":[{"code":"4302670","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Scl-70 (Scleroderma) Antibody Cvt","code_information":[{"code":"4302675","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Sm (Smith) Antibody Cvt","code_information":[{"code":"4302677","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Sm/rnp Antibody Cvt","code_information":[{"code":"4302672","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":346,"gross_charge":407,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Fx Metatrsl Clsd Woman Ea","code_information":[{"code":"4453126","type":"CDM"},{"code":"450","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":325,"maximum":345,"gross_charge":406,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345}]}]},{"description":"Fx Rad Shft Clsd Wo Manip","code_information":[{"code":"4453093","type":"CDM"},{"code":"450","type":"RC"},{"code":"25500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":325,"maximum":345,"gross_charge":406,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345}]}]},{"description":"12052 Rpr Layr Face 2.6-5.0cm","code_information":[{"code":"4453054","type":"CDM"},{"code":"761","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":325,"maximum":345,"gross_charge":406,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345}]}]},{"description":"Cchd Technetium Tc-99m","code_information":[{"code":"4341000","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":324,"maximum":344,"gross_charge":405,"discounted_cash":304,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344}]}]},{"description":"Us Scrotum (Contents)","code_information":[{"code":"4351030-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":324,"maximum":344,"gross_charge":405,"discounted_cash":304,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344}]}]},{"description":"90649 Ths Gardasil Sd Hpv Vacci","code_information":[{"code":"90649","type":"CDM"},{"code":"636","type":"RC"},{"code":"90649","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":318,"maximum":338,"gross_charge":398,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"25500 Closed Trtmt Of Radial Shaft Fx; W/o Manipulation Charge","code_information":[{"code":"25500","type":"CDM"},{"code":"521","type":"RC"},{"code":"25500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":336,"gross_charge":395,"discounted_cash":296,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"Closed Trtmt Of Tibial Fx, Proximal (Plateau); W/o Manipulation Charge","code_information":[{"code":"27530","type":"CDM"},{"code":"521","type":"RC"},{"code":"27530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":312,"maximum":332,"gross_charge":390,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332}]}]},{"description":"Treatment Of Ankle Fracture W/o Manipulation","code_information":[{"code":"27786","type":"CDM"},{"code":"521","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":312,"maximum":332,"gross_charge":390,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332}]}]},{"description":"99282- Ed Visit Level 2","code_information":[{"code":"4453002","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":312,"maximum":332,"gross_charge":390,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332}]}]},{"description":"12042 Rpr Lay;n,h,ft;2.6-7.5cm","code_information":[{"code":"4453048","type":"CDM"},{"code":"761","type":"RC"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":311,"maximum":331,"gross_charge":389,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"12051 Rpr Layr;face,ers;<2.5cm","code_information":[{"code":"4453053","type":"CDM"},{"code":"761","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":311,"maximum":331,"gross_charge":389,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"13153 Rpr Cpx;lid,n,e;add 5cm<","code_information":[{"code":"4453072","type":"CDM"},{"code":"761","type":"RC"},{"code":"13153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":311,"maximum":331,"gross_charge":389,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"26700 Dslc Knuckle Clsd Wo Ane","code_information":[{"code":"4453108","type":"CDM"},{"code":"761","type":"RC"},{"code":"26700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":311,"maximum":331,"gross_charge":389,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"30906 Subsq Contr Post Noseblee","code_information":[{"code":"4453150","type":"CDM"},{"code":"761","type":"RC"},{"code":"30906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":311,"maximum":331,"gross_charge":389,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"B. Pertussis/parapertus Pcr Cvt","code_information":[{"code":"4302515","type":"CDM"},{"code":"306","type":"RC"},{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":310,"maximum":330,"gross_charge":388,"discounted_cash":291,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330}]}]},{"description":"Fx Clsd Humeral Epicondylar Wo Manip","code_information":[{"code":"24560","type":"CDM"},{"code":"521","type":"RC"},{"code":"24560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":310,"maximum":329,"gross_charge":387,"discounted_cash":290,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329}]}]},{"description":"Us Pregnancy Limited","code_information":[{"code":"4351009-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":310,"maximum":329,"gross_charge":387,"discounted_cash":290,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329}]}]},{"description":"Meningococcal Conjugate Vaccine, Serogroups A, C, Y And W-135 (Tetravalent), For Im Use Poc","code_information":[{"code":"90734","type":"CDM"},{"code":"636","type":"RC"},{"code":"90734","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":326,"gross_charge":384,"discounted_cash":288,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"40652 Repair Lip ^1/2 Vert Heig","code_information":[{"code":"4453190","type":"CDM"},{"code":"761","type":"RC"},{"code":"40652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":326,"gross_charge":383,"discounted_cash":287,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"Aph Ffp Acda","code_information":[{"code":"4393126","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":305,"maximum":324,"gross_charge":381,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324}]}]},{"description":"Ffp Cpd","code_information":[{"code":"4393127","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":305,"maximum":324,"gross_charge":381,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324}]}]},{"description":"Pneumococcal Conjugate Vaccine, 13 Valent, For Intramuscular Use","code_information":[{"code":"90670","type":"CDM"},{"code":"636","type":"RC"},{"code":"90670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":305,"maximum":324,"gross_charge":381,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"90677 Prevnar 20 Cchd Mcd","code_information":[{"code":"90677","type":"CDM"},{"code":"636","type":"RC"},{"code":"90677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":304,"maximum":323,"gross_charge":380,"discounted_cash":285,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Psychiatric Diagnostic Evaluation","code_information":[{"code":"90791-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90791","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":304,"maximum":323,"gross_charge":380,"discounted_cash":285,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323}]}]},{"description":"Psychiatric Diagnostic Evaluation With Medical Services","code_information":[{"code":"90792-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90792","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":304,"maximum":323,"gross_charge":380,"discounted_cash":285,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323}]}]},{"description":"Psychotherapy, 30 min","code_information":[{"code":"90832-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90832","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":304,"maximum":323,"gross_charge":380,"discounted_cash":285,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323}]}]},{"description":"Psychotherapy, 45 min","code_information":[{"code":"90834-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90834","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":304,"maximum":323,"gross_charge":380,"discounted_cash":285,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323}]}]},{"description":"Psychotherapy, 60 min","code_information":[{"code":"90837-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90837","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":304,"maximum":323,"gross_charge":380,"discounted_cash":285,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323}]}]},{"description":"Us Abdomen Limited","code_information":[{"code":"4351003-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":302,"maximum":321,"gross_charge":378,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":321}]}]},{"description":"96413 Chemo/cmplx Infus 1st Hr","code_information":[{"code":"4455092","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":320,"gross_charge":377,"discounted_cash":283,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320}]}]},{"description":"11983-removal With Reinsertion, Non-biodegradable Drug Delivery Implant","code_information":[{"code":"11983","type":"CDM"},{"code":"521","type":"RC"},{"code":"11983","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":320,"gross_charge":377,"discounted_cash":283,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320}]}]},{"description":"27520 Fracture Patella Closed Clinic Charge","code_information":[{"code":"27520","type":"CDM"},{"code":"521","type":"RC"},{"code":"27520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":320,"gross_charge":377,"discounted_cash":283,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320}]}]},{"description":"29105 Apply Long Arm Splint.","code_information":[{"code":"4453132","type":"CDM"},{"code":"761","type":"RC"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":319,"gross_charge":375,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319}]}]},{"description":"29505 Apply Long Leg Splint","code_information":[{"code":"4453140","type":"CDM"},{"code":"761","type":"RC"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":319,"gross_charge":375,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319}]}]},{"description":"29515","code_information":[{"code":"4453141","type":"CDM"},{"code":"450","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":319,"gross_charge":375,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319}]}]},{"description":"Cath;indwell Bladder.comp Charge","code_information":[{"code":"4453171","type":"CDM"},{"code":"761","type":"RC"},{"code":"51703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":316,"gross_charge":372,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Debrid Sq Epdrm Drm 1st20","code_information":[{"code":"4453020","type":"CDM"},{"code":"450","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":316,"gross_charge":372,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Rpr Lay;n,h,ft,g;<2.5cm","code_information":[{"code":"4453047","type":"CDM"},{"code":"450","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":316,"gross_charge":372,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Rpr Lay;s,ax,g;2.6-7.5cm","code_information":[{"code":"4453042","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":316,"gross_charge":372,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"24650 Fx Rad He/nk Clsd Wo Mani","code_information":[{"code":"4453091","type":"CDM"},{"code":"761","type":"RC"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":316,"gross_charge":372,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"26641 Dscl Thumb Clsd W Manipul","code_information":[{"code":"4453104","type":"CDM"},{"code":"761","type":"RC"},{"code":"26641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":316,"gross_charge":372,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Autopulse Compressor Lifeband (Zoll)","code_information":[{"code":"4273011","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":291,"maximum":309,"gross_charge":364,"discounted_cash":273,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309}]}]},{"description":"11424 Remove Lesion, Scalp/neck/hand/foot 3.1 To 4.0 Cm Charge","code_information":[{"code":"11424","type":"CDM"},{"code":"521","type":"RC"},{"code":"11424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":291,"maximum":309,"gross_charge":364,"discounted_cash":273,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309}]}]},{"description":"Closed Trtmt Of Ulnar Fx, Proximal End (Olecranon Process); W/o Manipulation Charge","code_information":[{"code":"24670","type":"CDM"},{"code":"521","type":"RC"},{"code":"24670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":290,"maximum":308,"gross_charge":362,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308}]}]},{"description":"Debridement, Subcutaneous Tissue First 20 Sq Cm Or Less Technical Charge","code_information":[{"code":"11042","type":"CDM"},{"code":"521","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":290,"maximum":308,"gross_charge":362,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308}]}]},{"description":"Us Chest","code_information":[{"code":"4351002-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":288,"maximum":306,"gross_charge":360,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Us Head/neck Soft Tissue","code_information":[{"code":"4351000-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":288,"maximum":306,"gross_charge":360,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Us Pregnancy Multi Gest < 14 Weeks","code_information":[{"code":"4351021-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":288,"maximum":306,"gross_charge":360,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Xr Spine Cervical 6 Or More Views","code_information":[{"code":"4330297-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":288,"maximum":306,"gross_charge":360,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Xr Spine Entire 2-3 Views","code_information":[{"code":"4330280-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":288,"maximum":306,"gross_charge":360,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Cytomegalovirus Pcr Cvt","code_information":[{"code":"4302227","type":"CDM"},{"code":"306","type":"RC"},{"code":"87497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":286,"maximum":303,"gross_charge":357,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303}]}]},{"description":"Viral Cult;t-inoc Herpes, Varicella","code_information":[{"code":"4302296","type":"CDM"},{"code":"306","type":"RC"},{"code":"87252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":285,"maximum":303,"gross_charge":356,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303}]}]},{"description":"96112 Devel Test W/ Interp And Report First Hour","code_information":[{"code":"4380045","type":"CDM"},{"code":"442","type":"RC"},{"code":"96112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":284,"maximum":302,"gross_charge":355,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302}]}]},{"description":"Episiotomy/vag Repair","code_information":[{"code":"4453300","type":"CDM"},{"code":"450","type":"RC"},{"code":"59300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":301,"gross_charge":354,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301}]}]},{"description":"Remove Lesion, Face/lid/ear/nose/lip 2.1 To 3.0 Cm Charge","code_information":[{"code":"11443","type":"CDM"},{"code":"521","type":"RC"},{"code":"11443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":281,"maximum":298,"gross_charge":351,"discounted_cash":263,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"High Flow Oxygen Initial","code_information":[{"code":"4273098","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273098","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":280,"maximum":298,"gross_charge":350,"discounted_cash":263,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Helicobacter Pylori Breath Tst Cvt","code_information":[{"code":"4302389","type":"CDM"},{"code":"301","type":"RC"},{"code":"83013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":296,"gross_charge":348,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Hepatitis B Virus Dna, Quant Cvt","code_information":[{"code":"4302390","type":"CDM"},{"code":"306","type":"RC"},{"code":"87517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":296,"gross_charge":348,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"97166 Moderate Complexity Eval Charge","code_information":[{"code":"4409021","type":"CDM"},{"code":"430","type":"RC"},{"code":"97166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":296,"gross_charge":348,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Ot Evaluation Moderate Complexity","code_information":[{"code":"4400002","type":"CDM"},{"code":"430","type":"RC"},{"code":"97166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":296,"gross_charge":348,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Pt Eval Moderate Complexity 30 Mins Charge","code_information":[{"code":"4429020","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":296,"gross_charge":348,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Pt Evaluation Moderate Complexity","code_information":[{"code":"4423021","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":296,"gross_charge":348,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"10061 Drain Skin Abscess, Complex/multiple Charge","code_information":[{"code":"10061","type":"CDM"},{"code":"521","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":277,"maximum":294,"gross_charge":346,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294}]}]},{"description":"Initial Obs Care Level Iii Charge","code_information":[{"code":"4447110-AQ","type":"CDM"},{"code":"99220","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":276,"maximum":293,"gross_charge":345,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293}]}]},{"description":"Enterovirus Rna, Qual R Cvt","code_information":[{"code":"4302230","type":"CDM"},{"code":"306","type":"RC"},{"code":"87498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":292,"gross_charge":344,"discounted_cash":258,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"16030 Burn Par Thicik >10% Tbsa","code_information":[{"code":"4453077","type":"CDM"},{"code":"761","type":"RC"},{"code":"16030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":287,"gross_charge":338,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"27780 Fx Fib Prox Shft Clsd Wom","code_information":[{"code":"4453118","type":"CDM"},{"code":"761","type":"RC"},{"code":"27780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":287,"gross_charge":338,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"41251 Rpr Lac Post Tng <2.5cm","code_information":[{"code":"4453165","type":"CDM"},{"code":"761","type":"RC"},{"code":"41251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":287,"gross_charge":338,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"67700 Drainage Abscess; Eyelid","code_information":[{"code":"4454050","type":"CDM"},{"code":"761","type":"RC"},{"code":"67700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":287,"gross_charge":338,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"26600 Fracture Metacarpal (Single) Clinic Charge","code_information":[{"code":"26600","type":"CDM"},{"code":"521","type":"RC"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":287,"gross_charge":338,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"28400 Closed Trtmt Of Calcaneal Fx; W/o Manipulation Charge","code_information":[{"code":"28400","type":"CDM"},{"code":"521","type":"RC"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":287,"gross_charge":338,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"28450 Fracture Tarsal Bones Clinic Charge","code_information":[{"code":"28450","type":"CDM"},{"code":"521","type":"RC"},{"code":"28450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":287,"gross_charge":338,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287}]}]},{"description":"90697 Vaxelis Vaccine (Dtap-ipv-hib-hepb) Private","code_information":[{"code":"90697-AM","type":"CDM"},{"code":"636","type":"RC"},{"code":"90697","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":269,"maximum":286,"gross_charge":336,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Alpha Fetopro,l3 Cvt","code_information":[{"code":"4302069","type":"CDM"},{"code":"301","type":"RC"},{"code":"82107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":282,"gross_charge":332,"discounted_cash":249,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282}]}]},{"description":"40830 Rpr Lac <2.5cm Vest Mouth","code_information":[{"code":"4453162","type":"CDM"},{"code":"761","type":"RC"},{"code":"40830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":282,"gross_charge":332,"discounted_cash":249,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282}]}]},{"description":"Quantiferon (R) Tb Gold Cvt","code_information":[{"code":"4302697","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":281,"gross_charge":330,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281}]}]},{"description":"Roam Alert Sensor Tag Cvl Roam-alert System","code_information":[{"code":"4273803","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273803","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":281,"gross_charge":330,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281}]}]},{"description":"23600 Closed Trtmt Of Proximal Humeral (Surgical Or Anatomical Neck) Fx; W/o Manipulation Charge","code_information":[{"code":"23600","type":"CDM"},{"code":"521","type":"RC"},{"code":"23600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":263,"maximum":280,"gross_charge":329,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Dressing Vac Veraflo System Med.","code_information":[{"code":"4273079","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273079","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":262,"maximum":279,"gross_charge":328,"discounted_cash":246,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"64400 Injection, Anesthetic Agent; Trigeminal Nerve","code_information":[{"code":"64400","type":"CDM"},{"code":"521","type":"RC"},{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":276,"gross_charge":325,"discounted_cash":244,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Tb Test, T-spot (Oxford)","code_information":[{"code":"4302002","type":"CDM"},{"code":"302","type":"RC"},{"code":"86481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":271,"gross_charge":319,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271}]}]},{"description":"99487complex Chronic Care Management; First 60 Minutes","code_information":[{"code":"99487","type":"CDM"},{"code":"521","type":"RC"},{"code":"99487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":271,"gross_charge":319,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271}]}]},{"description":"99235 Same Day Admit/disch Ii Charge","code_information":[{"code":"4447116-AQ","type":"CDM"},{"code":"99235","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":255,"maximum":271,"gross_charge":319,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271}]}]},{"description":"Pf Rmvl Fb Xtrnl Auditory Canal W/o Anes","code_information":[{"code":"69200","type":"CDM"},{"code":"521","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":254,"maximum":270,"gross_charge":318,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Shoulder/immobilizer/lg","code_information":[{"code":"4273588","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":253,"maximum":269,"gross_charge":316,"discounted_cash":237,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269}]}]},{"description":"N-telo,collagen Cross-linked Cvt","code_information":[{"code":"4302254","type":"CDM"},{"code":"301","type":"RC"},{"code":"82523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":251,"maximum":267,"gross_charge":314,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267}]}]},{"description":"Post-tr Xm Ahg","code_information":[{"code":"4300868","type":"CDM"},{"code":"300","type":"RC"},{"code":"86922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"X-match Ahg Interp","code_information":[{"code":"4300269","type":"CDM"},{"code":"302","type":"RC"},{"code":"86922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Cast Applica Short Arm","code_information":[{"code":"4453256","type":"CDM"},{"code":"450","type":"RC"},{"code":"29075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Casting Shrt Leg Fibrglas","code_information":[{"code":"4453971","type":"CDM"},{"code":"450","type":"RC"},{"code":"29405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"11406 Remove Lesion, Trunk/arm/leg >4.0 Cm Charge","code_information":[{"code":"11406","type":"CDM"},{"code":"521","type":"RC"},{"code":"11406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"28470 Closed Trtmt Of Metatarsal Fx; W/o Manipulation, Each Charge","code_information":[{"code":"28470","type":"CDM"},{"code":"521","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Repair Simple  Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 12.6 Cm To 20.0 Cm Charge","code_information":[{"code":"12005","type":"CDM"},{"code":"521","type":"RC"},{"code":"12005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Anti-double Strand Dna Ab Cvt","code_information":[{"code":"4302127","type":"CDM"},{"code":"302","type":"RC"},{"code":"86225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Abdomial ultrasound of pregnant uterus","code_information":[{"code":"4351005","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":265,"gross_charge":312,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"99306 Initial Swingbed Level3","code_information":[{"code":"99306-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99306","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":249,"maximum":264,"gross_charge":311,"discounted_cash":233,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Dengue Fever Ab Igg, Igm Cvt","code_information":[{"code":"4302750","type":"CDM"},{"code":"302","type":"RC"},{"code":"86790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":247,"maximum":263,"gross_charge":309,"discounted_cash":232,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Us Extremity Nonvascular Ltd Lt","code_information":[{"code":"4351014-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":262,"gross_charge":308,"discounted_cash":231,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262}]}]},{"description":"Us Extremity Nonvascular Ltd Rt","code_information":[{"code":"4351033-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":262,"gross_charge":308,"discounted_cash":231,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262}]}]},{"description":"Excision Of Lesion Of Mucosa And Submucosa, Vestibule Of Mouth; With Simple Repair Technical Charge","code_information":[{"code":"40812","type":"CDM"},{"code":"521","type":"RC"},{"code":"40812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":262,"gross_charge":308,"discounted_cash":231,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262}]}]},{"description":"13133 Rpr Compx;fh,ch;add 5cm<","code_information":[{"code":"4453068","type":"CDM"},{"code":"761","type":"RC"},{"code":"13133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245,"maximum":260,"gross_charge":306,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Xr Spine Lumbosacral Complete Min 6 Views","code_information":[{"code":"4330294-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":245,"maximum":260,"gross_charge":306,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Hepatitis Acute Panel Cvt","code_information":[{"code":"4302409","type":"CDM"},{"code":"301","type":"RC"},{"code":"80074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":244,"maximum":259,"gross_charge":305,"discounted_cash":229,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259}]}]},{"description":"29125","code_information":[{"code":"4453133","type":"CDM"},{"code":"450","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"29130 Apl Fng Splnt Static","code_information":[{"code":"4453134","type":"CDM"},{"code":"450","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Facility Simple Epistaxis Control","code_information":[{"code":"4453147","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Remove Fb Ear Canal Wo/an","code_information":[{"code":"4453180","type":"CDM"},{"code":"450","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Collection: Arterial Draw","code_information":[{"code":"4300140","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Puncture Arterial Diagonsis Charge","code_information":[{"code":"3113060","type":"CDM"},{"code":"761","type":"RC"},{"code":"36600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Straight Cath For Res Uri Charge","code_information":[{"code":"4453160","type":"CDM"},{"code":"761","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Insert Foley Cath Tech Chg","code_information":[{"code":"4453193","type":"CDM"},{"code":"450","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Cv Holter Monitor 48 Hour","code_information":[{"code":"4732004-TC","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Us Cardiac Holter Monitor Up To 48 Hours","code_information":[{"code":"4732004","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Hhn Continuous 1st Hr","code_information":[{"code":"4413024","type":"CDM"},{"code":"412","type":"RC"},{"code":"94644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Inj Trigr Pts =/>3","code_information":[{"code":"4453259","type":"CDM"},{"code":"450","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"26670 Dslc Hand Clsd W Manipula","code_information":[{"code":"4453107","type":"CDM"},{"code":"761","type":"RC"},{"code":"26670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"27200 Fx Coccygeal Clsd Tx","code_information":[{"code":"4453114","type":"CDM"},{"code":"761","type":"RC"},{"code":"27200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":258,"gross_charge":304,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Zoster (Shingles) Vaccine (Hzv), Recombinant, Subunit, Adjuvanted, For Intramuscular Use","code_information":[{"code":"90750","type":"CDM"},{"code":"636","type":"RC"},{"code":"90750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":242,"maximum":258,"gross_charge":303,"discounted_cash":227,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"49099204","type":"CDM"},{"code":"521","type":"RC"},{"code":"99204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":255,"gross_charge":300,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"11423 Remove Lesion, Scalp/neck/hand/foot 2.1 To 3.0 Cm Charge","code_information":[{"code":"11423","type":"CDM"},{"code":"521","type":"RC"},{"code":"11423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":254,"gross_charge":299,"discounted_cash":224,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254}]}]},{"description":"12041 Layer Closure Of Wounds Of Neck, Hands, Feet And/or Ext Genit; 2.5 Cm Or Less Charge Tech Chg","code_information":[{"code":"12041","type":"CDM"},{"code":"521","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":252,"gross_charge":297,"discounted_cash":223,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252}]}]},{"description":"New patient office or other outpatient visit, 60 min","code_information":[{"code":"99205-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99205","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":237,"maximum":252,"gross_charge":296,"discounted_cash":222,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252}]}]},{"description":"11302 Shaving Of Epidermal Or Dermal Lesion, Single Lesion, Trunk, Arms Or Legs; Lesion 1.1 To 2.0cm","code_information":[{"code":"11302","type":"CDM"},{"code":"521","type":"RC"},{"code":"11302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":237,"maximum":252,"gross_charge":296,"discounted_cash":222,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252}]}]},{"description":"20553 Inj(s); Single Or Mult Trigger Point(s), Three Or More Muscle(s) Charge","code_information":[{"code":"20553","type":"CDM"},{"code":"521","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":237,"maximum":252,"gross_charge":296,"discounted_cash":222,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252}]}]},{"description":"Bd Bone Density Dexa Axial Skeleton","code_information":[{"code":"4330500-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":236,"maximum":251,"gross_charge":295,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251}]}]},{"description":"Artho,asp,major Jnt,bursa","code_information":[{"code":"4453080","type":"CDM"},{"code":"450","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":245,"gross_charge":288,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Antigen Id Compatibility Per Id Per Unit (Cmbc)","code_information":[{"code":"4302049","type":"CDM"},{"code":"309","type":"RC"},{"code":"86905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":245,"gross_charge":288,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Us Pregnancy Follow Up","code_information":[{"code":"4351010","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":245,"gross_charge":288,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"42700 I&d Abscess Tonsillar","code_information":[{"code":"4454162","type":"CDM"},{"code":"761","type":"RC"},{"code":"42700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":245,"gross_charge":288,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Splint Dynapro Finger Flex Orthosis","code_information":[{"code":"4273263","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273263","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":245,"gross_charge":288,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Fx Mtcrpl Clsd Sngl Wo Ma","code_information":[{"code":"4453102","type":"CDM"},{"code":"450","type":"RC"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":244,"gross_charge":287,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244}]}]},{"description":"23540 Dslc Ac Clsd Wo Manipulat","code_information":[{"code":"4453085","type":"CDM"},{"code":"761","type":"RC"},{"code":"23540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":244,"gross_charge":287,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244}]}]},{"description":"11900 Scar Injection [Cchd]","code_information":[{"code":"49011900","type":"CDM"},{"code":"761","type":"RC"},{"code":"11900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":243,"gross_charge":286,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243}]}]},{"description":"11442 Remove Lesion, Face/lid/ear/nose/lip 1.1 To 2.0 Cm Charge","code_information":[{"code":"11442","type":"CDM"},{"code":"521","type":"RC"},{"code":"11442","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":243,"gross_charge":286,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243}]}]},{"description":"12032layer Closure Of Wounds Of Scalp, Axillae, Trunk, Extrem(exclude Hands And Feet) 2.6 Cm To 07.5","code_information":[{"code":"12032","type":"CDM"},{"code":"521","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":243,"gross_charge":286,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243}]}]},{"description":"Closed Tx Of Radial Head/neck Fx; Without Manipulation","code_information":[{"code":"24650","type":"CDM"},{"code":"521","type":"RC"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":243,"gross_charge":286,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243}]}]},{"description":"Varicella Virus Vaccine Poc","code_information":[{"code":"90716","type":"CDM"},{"code":"636","type":"RC"},{"code":"90716","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":228,"maximum":242,"gross_charge":285,"discounted_cash":214,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Standardized Cognitive Eval Minutes","code_information":[{"code":"4380016","type":"CDM"},{"code":"444","type":"RC"},{"code":"96125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":227,"maximum":241,"gross_charge":284,"discounted_cash":213,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Cathetr Midline Kit","code_information":[{"code":"4273955","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":241,"gross_charge":283,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"26755 Closed Trtmt Of Distal Phalangeal Fx, Finger Or Thumb; W/manipulation","code_information":[{"code":"4454062","type":"CDM"},{"code":"450","type":"RC"},{"code":"26755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":241,"gross_charge":283,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Fx Big Toe Clsd Wo Manip","code_information":[{"code":"4453128","type":"CDM"},{"code":"450","type":"RC"},{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":241,"gross_charge":283,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Fx Dis Phal Clsd Wo Manip","code_information":[{"code":"4453111","type":"CDM"},{"code":"450","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":241,"gross_charge":283,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"26720 Closed Tx Of Phalangeal Shaft Fx, Proximal Or Midlle Phal, Finger Or Thumb: Without Manipu,","code_information":[{"code":"26720","type":"CDM"},{"code":"521","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":238,"gross_charge":280,"discounted_cash":210,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"Xr Spine Cervical 4 Or 5 Views","code_information":[{"code":"4330296-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":223,"maximum":237,"gross_charge":279,"discounted_cash":209,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237}]}]},{"description":"96110 Developmental Screen W/ Score Charge","code_information":[{"code":"4380040","type":"CDM"},{"code":"441","type":"RC"},{"code":"96110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":235,"gross_charge":276,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"96105 Asses Of Aphasia Per Hour","code_information":[{"code":"4380035","type":"CDM"},{"code":"442","type":"RC"},{"code":"96105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":235,"gross_charge":276,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Op Visit Level V","code_information":[{"code":"4473034","type":"CDM"},{"code":"761","type":"RC"},{"code":"99215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":219,"maximum":233,"gross_charge":274,"discounted_cash":206,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233}]}]},{"description":"12004 Repair Simple  Scalp, Neck, Axillae, Ext. Gen, Trunk And/or Extrem; 7.6 Cm To 12.5 Cm Charge","code_information":[{"code":"12004","type":"CDM"},{"code":"521","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":232,"gross_charge":273,"discounted_cash":205,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232}]}]},{"description":"96125 Cognitive Test By Hc Pro Per Hour","code_information":[{"code":"4380050","type":"CDM"},{"code":"444","type":"RC"},{"code":"96125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":230,"gross_charge":271,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Ex/enec Thromb Ex Hemorho","code_information":[{"code":"4453215","type":"CDM"},{"code":"450","type":"RC"},{"code":"46320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":230,"gross_charge":270,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"23570 Fx Scapula Clsd Wo Manipu","code_information":[{"code":"4456357","type":"CDM"},{"code":"761","type":"RC"},{"code":"23570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":230,"gross_charge":270,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Xr Skull Complete","code_information":[{"code":"4330273-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":216,"maximum":230,"gross_charge":270,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Xr Spine Thoracic Minimum 4 Views","code_information":[{"code":"4330286-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":216,"maximum":230,"gross_charge":270,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Arthro,asp,inj;int Jt/bur","code_information":[{"code":"4453079","type":"CDM"},{"code":"450","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":228,"gross_charge":268,"discounted_cash":201,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228}]}]},{"description":"Ultrasound of abdomen","code_information":[{"code":"4351001","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":228,"gross_charge":268,"discounted_cash":201,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228}]}]},{"description":"92522 Eval Speech Sound Production","code_information":[{"code":"4380012","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":225,"gross_charge":265,"discounted_cash":199,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225}]}]},{"description":"Sulfonylurea Hypoglycemic Panel Bill Only","code_information":[{"code":"43080377","type":"CDM"},{"code":"301","type":"RC"},{"code":"80377","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":211,"maximum":224,"gross_charge":264,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"Hepatitis C Viral Rna, Quant Cvt","code_information":[{"code":"4302416","type":"CDM"},{"code":"306","type":"RC"},{"code":"87522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"64405 Inj, Anesthetic Agent; Greater Occipital Nerve Charge","code_information":[{"code":"64405","type":"CDM"},{"code":"521","type":"RC"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Abdomen 2 Views","code_information":[{"code":"4330105-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Abdomen Acute 3 Views/chest 1 View","code_information":[{"code":"4330107-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Facial Bones Minimum 3 Views","code_information":[{"code":"4330173-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Hand 2 Views Left","code_information":[{"code":"4330200-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Hand 2 Views Right","code_information":[{"code":"4330201-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Hips Bil W/ Pelvis 2 Views","code_information":[{"code":"4330246-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Knee Complete Left","code_information":[{"code":"4330218-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Knee Complete Right","code_information":[{"code":"4330219-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Orbits Complete Bilateral","code_information":[{"code":"4330235-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Pelvis 1 Or 2 Views","code_information":[{"code":"4330243-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Pelvis Complete Minimum 3 Views","code_information":[{"code":"4330244-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Ribs 2 Views Left","code_information":[{"code":"4330253-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Ribs 2 Views Right","code_information":[{"code":"4330252-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Ribs Min 3 Views Left W/ Pa Chest","code_information":[{"code":"4330260-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Ribs Min 3 Views Right W/ Pa Chest","code_information":[{"code":"4330261-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Ribs W/ Pa Chest Bilateral Min 4 Views","code_information":[{"code":"4330254-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Sacroiliac Joints Minimum 3 Views","code_information":[{"code":"4330256-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Skull < 4 Views","code_information":[{"code":"4330271-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Spine Lumbosacral 2 Or 3 Views","code_information":[{"code":"4330291-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"X-Ray of lower back","code_information":[{"code":"4330293-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Spine Thoracic 2 Views","code_information":[{"code":"4330283-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Spine Thoracic 3 Views","code_information":[{"code":"4330282-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":210,"maximum":223,"gross_charge":262,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"99387 Preventive Medicine 65+ Years New","code_information":[{"code":"99387-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99387","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":209,"maximum":222,"gross_charge":261,"discounted_cash":196,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}]},{"description":"Adrenocorticotropic Hormone Cvt","code_information":[{"code":"4302110","type":"CDM"},{"code":"301","type":"RC"},{"code":"82024","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":221,"gross_charge":260,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Aldosterone Cvt","code_information":[{"code":"4302116","type":"CDM"},{"code":"301","type":"RC"},{"code":"82088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":221,"gross_charge":260,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"11404 Remove Lesion, Trunk/arm/leg 3.1 To 4.0 Cm Charge","code_information":[{"code":"11404","type":"CDM"},{"code":"521","type":"RC"},{"code":"11404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":221,"gross_charge":260,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"12014repair Simple  Face, Ears, Eyelids, Nose, Lips And/or Mucous Membranes; 5.1 Cm To 7.5 Cm Charge","code_information":[{"code":"12014","type":"CDM"},{"code":"521","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":221,"gross_charge":260,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Excision, Malignant Lesion, Trunk, Arms, Or Legs;1.1 To 2.0 Cm Technical Charge","code_information":[{"code":"11602","type":"CDM"},{"code":"521","type":"RC"},{"code":"11602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":221,"gross_charge":260,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Respiratory Syncytial Virus, Pcr Id Now","code_information":[{"code":"4400006","type":"CDM"},{"code":"306","type":"RC"},{"code":"87634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":206,"maximum":218,"gross_charge":257,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"99152 Moderate Sedation Initial, 15 Mins","code_information":[{"code":"49099152","type":"CDM"},{"code":"761","type":"RC"},{"code":"99152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":216,"gross_charge":254,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"13122 Rpr Compx;sc,ex;addl 5cm<","code_information":[{"code":"4453065","type":"CDM"},{"code":"761","type":"RC"},{"code":"13122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":216,"gross_charge":254,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"30903 Control Ant Nosebleed Cmx","code_information":[{"code":"4453148","type":"CDM"},{"code":"761","type":"RC"},{"code":"30903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":216,"gross_charge":254,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"97606 Wound Neg Pres 750 Sq Cm","code_information":[{"code":"4476002","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":216,"gross_charge":254,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"99143 Conscious Sedation < 5yrs","code_information":[{"code":"4456450","type":"CDM"},{"code":"372","type":"RC"},{"code":"99151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":216,"gross_charge":254,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"99152 Conscious Sedation >5yrs Profee","code_information":[{"code":"4456451","type":"CDM"},{"code":"370","type":"RC"},{"code":"99152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":216,"gross_charge":254,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"92610 Eval Oral/phar Swallowing","code_information":[{"code":"4380080","type":"CDM"},{"code":"441","type":"RC"},{"code":"92610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":216,"gross_charge":254,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"99234 Same Day Admit/disch I Charge","code_information":[{"code":"4447115-AQ","type":"CDM"},{"code":"99234","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":203,"maximum":216,"gross_charge":254,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"99397 Periodic Comprehensive Preventive ( Established Patient; 65 Years +)","code_information":[{"code":"99397-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99397","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":202,"maximum":215,"gross_charge":253,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Splint Ankle Air Stirrup","code_information":[{"code":"4273653","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":215,"gross_charge":253,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"CT scan","code_information":[{"code":"4360135","type":"CDM"},{"code":"350","type":"RC"},{"code":"70450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":214,"gross_charge":252,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Oxygen Per Day","code_information":[{"code":"4273270","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273270","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":214,"gross_charge":252,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Drug Abuse Panel 9, Serum Cvt","code_information":[{"code":"4302251","type":"CDM"},{"code":"301","type":"RC"},{"code":"80307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":201,"maximum":213,"gross_charge":251,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Urine Drug Screen Standard","code_information":[{"code":"4300027","type":"CDM"},{"code":"301","type":"RC"},{"code":"80307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":201,"maximum":213,"gross_charge":251,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Initial Obs Care Level Ii Charge","code_information":[{"code":"4447109-AQ","type":"CDM"},{"code":"99219","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":201,"maximum":213,"gross_charge":251,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Room/bed: Observation Special Equipment 1st Hour","code_information":[{"code":"4460006","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":213,"gross_charge":250,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"92526 Treatment Swallow Dysfunction","code_information":[{"code":"4380025","type":"CDM"},{"code":"441","type":"RC"},{"code":"92526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":213,"gross_charge":250,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Dressing Iodosorb Gel","code_information":[{"code":"4273203","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273203","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":212,"gross_charge":249,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Op Visit Level Iv","code_information":[{"code":"4473033","type":"CDM"},{"code":"761","type":"RC"},{"code":"99214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":212,"gross_charge":249,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"92597 Eval Oral Speech Device","code_information":[{"code":"4380030","type":"CDM"},{"code":"441","type":"RC"},{"code":"92597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":212,"gross_charge":249,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"12011 Rpr Sf Felnlm <2.6cm Pro Ed Charge","code_information":[{"code":"CP17667781912891511","type":"CDM"},{"code":"CP17667781912891511","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":212,"gross_charge":249,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"99310 Subsequent Swingbed: Skilled(level 4)","code_information":[{"code":"99310-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99310","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":199,"maximum":212,"gross_charge":249,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Subseq Snf/nh Level Iv Charge","code_information":[{"code":"4447126-AQ","type":"CDM"},{"code":"99310","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":199,"maximum":212,"gross_charge":249,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Catheter Suprapubic Tray","code_information":[{"code":"4273973","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":211,"gross_charge":248,"discounted_cash":186,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"Arthro,asp,inj;sm Jt,burs","code_information":[{"code":"4453078","type":"CDM"},{"code":"450","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":211,"gross_charge":248,"discounted_cash":186,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"99204-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99204","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":198,"maximum":210,"gross_charge":247,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210}]}]},{"description":"11441 Remove Lesion, Face/lid/ear/nose/lip .6 To 1.0 Cm Charge","code_information":[{"code":"11441","type":"CDM"},{"code":"521","type":"RC"},{"code":"11441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":210,"gross_charge":247,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210}]}]},{"description":"Dressing Interdry Ag 10x12'","code_information":[{"code":"4273155","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273155","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":209,"gross_charge":246,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"Ot Evaluation Moderate Complexityevaluation Charge","code_information":[{"code":"4400005","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":209,"gross_charge":246,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"Chikungunya Ab W/rflx To Titer Cvt","code_information":[{"code":"4302756","type":"CDM"},{"code":"302","type":"RC"},{"code":"86790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":209,"gross_charge":246,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"92507 Treatment Of Speech, Language, Voice, Communication","code_information":[{"code":"4380005","type":"CDM"},{"code":"441","type":"RC"},{"code":"92507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":209,"gross_charge":246,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"99305 Initial Swingbed Level2","code_information":[{"code":"99305-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99305","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":195,"maximum":207,"gross_charge":244,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"Pt Manual Charges Cch","code_information":[{"code":"4423020","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":207,"gross_charge":244,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"97161 Pt Evaluation: Low Complexity","code_information":[{"code":"4429019","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":207,"gross_charge":244,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"Bill Surgpath Level V 88307","code_information":[{"code":"4306086","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":204,"gross_charge":240,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"77003 Fluoroscopic Guidance And Localization Of Needle Or Cather Tip For Spine Or Paraspinous Diagno","code_information":[{"code":"49077003-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":192,"maximum":204,"gross_charge":240,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Fluoroscopic Guidance For Needle Placement","code_information":[{"code":"49077002","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":204,"gross_charge":240,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Airtraq Sz 2 Small Video Intubation Unit","code_information":[{"code":"4273002","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":204,"gross_charge":240,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Airtraq Sz 3  Reg Video Intubation","code_information":[{"code":"4273004","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":204,"gross_charge":240,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"49099203","type":"CDM"},{"code":"521","type":"RC"},{"code":"99203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":204,"gross_charge":240,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Electrode Physio Lf/pk Pedi Defib Pad","code_information":[{"code":"4273629","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273629","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":204,"gross_charge":240,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Initial new patient preventative medicine evaluation (40-64 years)","code_information":[{"code":"99386-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99386","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":191,"maximum":203,"gross_charge":239,"discounted_cash":179,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Polar Pac Wrap-on Multi Xl","code_information":[{"code":"4273923","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273923","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":190,"maximum":202,"gross_charge":238,"discounted_cash":179,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"41250 Rpr Lac Ant Mth/tng2.5cm<","code_information":[{"code":"4453164","type":"CDM"},{"code":"761","type":"RC"},{"code":"41250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":190,"maximum":201,"gross_charge":237,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"G2025 Telehealth","code_information":[{"code":"G2025","type":"CDM"},{"code":"521","type":"RC"},{"code":"G2025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":201,"gross_charge":236,"discounted_cash":177,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"C. Difficile Pcr Cvt","code_information":[{"code":"4302232","type":"CDM"},{"code":"306","type":"RC"},{"code":"87493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":199,"gross_charge":234,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Cobalt, Blood Cvt","code_information":[{"code":"4302068","type":"CDM"},{"code":"301","type":"RC"},{"code":"83018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":199,"gross_charge":234,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Xr Ribs 3 Views Bilateral","code_information":[{"code":"4330251-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":187,"maximum":199,"gross_charge":234,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Xr Temporomandibular Joints","code_information":[{"code":"4330305-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70330","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":187,"maximum":199,"gross_charge":234,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"11422 Remove Lesion, Scalp/neck/hand/foot 1.1 To 2.0 Cm Charge","code_information":[{"code":"11422","type":"CDM"},{"code":"521","type":"RC"},{"code":"11422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":199,"gross_charge":234,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"26750 Closed Trtmt Of Distal Phalangeal Fx, Finger Or Thumb; W/o Manipulation, Each Charge","code_information":[{"code":"26750","type":"CDM"},{"code":"521","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":199,"gross_charge":234,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/or","code_information":[{"code":"12002","type":"CDM"},{"code":"521","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":199,"gross_charge":234,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"97165 Ot Eval, Low Complexity 30 Min.","code_information":[{"code":"4409020","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":197,"gross_charge":232,"discounted_cash":174,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197}]}]},{"description":"97165 Ot Eval Low Complex 30 Min (Untimed)","code_information":[{"code":"CP17667781911645369","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":197,"gross_charge":232,"discounted_cash":174,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197}]}]},{"description":"Pt Evaluation High Complexity Units","code_information":[{"code":"CP17667781911675434","type":"CDM"},{"code":"CP17667781911675434","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":197,"gross_charge":232,"discounted_cash":174,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197}]}]},{"description":"92524 Behavioral And Qualitative Analysis Of Voice And Resonance","code_information":[{"code":"4380014","type":"CDM"},{"code":"444","type":"RC"},{"code":"92524","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":197,"gross_charge":232,"discounted_cash":174,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197}]}]},{"description":"29126 Ot Splint Short Arm Dynamic","code_information":[{"code":"4409002","type":"CDM"},{"code":"431","type":"RC"},{"code":"29126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":196,"gross_charge":231,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"29126 Splint Short Arm Dynamic","code_information":[{"code":"4404007","type":"CDM"},{"code":"431","type":"RC"},{"code":"29126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":196,"gross_charge":231,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"29131 Ot Splint Finger Dynamic","code_information":[{"code":"4409004","type":"CDM"},{"code":"431","type":"RC"},{"code":"29131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":196,"gross_charge":231,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"29131 Splint Finger Dynamic","code_information":[{"code":"4404009","type":"CDM"},{"code":"431","type":"RC"},{"code":"29131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":196,"gross_charge":231,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"10120 Fb Removal Simple Pro Ed Charge","code_information":[{"code":"CP17667781912890496","type":"CDM"},{"code":"CP17667781912890496","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":196,"gross_charge":231,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"10021 Fine Needle Aspiration; Without Imaging Guidance","code_information":[{"code":"10021","type":"CDM"},{"code":"521","type":"RC"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":196,"gross_charge":230,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"General Health Panel","code_information":[{"code":"80050","type":"CDM"},{"code":"300","type":"RC"},{"code":"80050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":195,"gross_charge":229,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195}]}]},{"description":"40804 Removal Fb Vest Mouth Sim","code_information":[{"code":"4454095","type":"CDM"},{"code":"761","type":"RC"},{"code":"40804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":194,"gross_charge":228,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194}]}]},{"description":"42809 Remov Fb From Pharynx","code_information":[{"code":"4453212","type":"CDM"},{"code":"761","type":"RC"},{"code":"42809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":194,"gross_charge":228,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194}]}]},{"description":"Op Visit Level Iii","code_information":[{"code":"4473032","type":"CDM"},{"code":"761","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":192,"gross_charge":226,"discounted_cash":170,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"Gad 65 Ab Cvt","code_information":[{"code":"4302047","type":"CDM"},{"code":"302","type":"RC"},{"code":"86341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":192,"gross_charge":226,"discounted_cash":170,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"Metanephrines Free, Pl Cvt","code_information":[{"code":"4302004","type":"CDM"},{"code":"301","type":"RC"},{"code":"83835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":191,"gross_charge":225,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"Xr Chest 3 Views","code_information":[{"code":"4330150-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71047","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":180,"maximum":191,"gross_charge":225,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"Xr Chest 4 Views Or More","code_information":[{"code":"4330148-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71048","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":180,"maximum":191,"gross_charge":225,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"Dslc Ip Jt Clsd W Man Woa","code_information":[{"code":"4453112","type":"CDM"},{"code":"450","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":191,"gross_charge":225,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"87591 Neiss Gonorrhoeae Pcr Cvt","code_information":[{"code":"4302417","type":"CDM"},{"code":"306","type":"RC"},{"code":"87591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":190,"gross_charge":224,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Chlamydia Trachomatis Pcr Cvt","code_information":[{"code":"CP17667781911032394","type":"CDM"},{"code":"CP17667781911032394","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":190,"gross_charge":224,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Chlamydia Trachomatis Pcr Cvt","code_information":[{"code":"4302678","type":"CDM"},{"code":"306","type":"RC"},{"code":"87491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":190,"gross_charge":224,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Herpes Simplex 1/2,dna Qual Cvt","code_information":[{"code":"4302021","type":"CDM"},{"code":"306","type":"RC"},{"code":"87529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":190,"gross_charge":224,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Chest Tube Insertion Tray","code_information":[{"code":"4273018","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":190,"gross_charge":224,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"90732 Pneumococcal  23-valent Adult Vaccine Poc","code_information":[{"code":"90732-AM","type":"CDM"},{"code":"636","type":"RC"},{"code":"90732","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":178,"maximum":190,"gross_charge":223,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Zonisamide Cvt","code_information":[{"code":"4302707","type":"CDM"},{"code":"301","type":"RC"},{"code":"80203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":190,"gross_charge":223,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Office/op Established  Visit Level 5 99215","code_information":[{"code":"99215-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99215","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":178,"maximum":190,"gross_charge":223,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Diphth/hepb/pertussis,acel/polio/tetanus Vaccine Poc","code_information":[{"code":"90723","type":"CDM"},{"code":"636","type":"RC"},{"code":"90723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":190,"gross_charge":223,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Burn Par Thick 5-10% Tbsa","code_information":[{"code":"4453076","type":"CDM"},{"code":"450","type":"RC"},{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":189,"gross_charge":222,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Paring/cutting Sngl Les","code_information":[{"code":"4453252","type":"CDM"},{"code":"450","type":"RC"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":189,"gross_charge":222,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Removalskintags;upto15","code_information":[{"code":"4453198","type":"CDM"},{"code":"450","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":189,"gross_charge":222,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Arginine Vasopressin Cvt","code_information":[{"code":"4302112","type":"CDM"},{"code":"301","type":"RC"},{"code":"84588","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":188,"gross_charge":221,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Brain Natriuretic Peptide (Bnp)","code_information":[{"code":"4300576","type":"CDM"},{"code":"301","type":"RC"},{"code":"83880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":188,"gross_charge":221,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"12013repair Simple  Face, Ears, Eyelids, Nose, Lips And/or Mucous Membranes; 2.6 Cm To 5.0 Cm Charge","code_information":[{"code":"12013","type":"CDM"},{"code":"521","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":188,"gross_charge":221,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"28190 Removal Of Foreign Body, Foot; Subcutaneous Charge","code_information":[{"code":"28190","type":"CDM"},{"code":"521","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":188,"gross_charge":221,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Remove Drug Implant","code_information":[{"code":"11982","type":"CDM"},{"code":"521","type":"RC"},{"code":"11982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":188,"gross_charge":221,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"90680 Rotavirus Vaccine, Pentavalent, 3 Dose Schedule, Live, For Oral Use","code_information":[{"code":"90680","type":"CDM"},{"code":"636","type":"RC"},{"code":"90680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":188,"gross_charge":221,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"I&d Bartholin Gland Abces","code_information":[{"code":"4453174","type":"CDM"},{"code":"450","type":"RC"},{"code":"56420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":187,"gross_charge":220,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"Calprotectin Stool Cvt","code_information":[{"code":"4302915","type":"CDM"},{"code":"301","type":"RC"},{"code":"83993","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":187,"gross_charge":220,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"Pth Intact Cvt","code_information":[{"code":"4302589","type":"CDM"},{"code":"301","type":"RC"},{"code":"83970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":187,"gross_charge":220,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"24500 Fx Humeral Shft Clsd Woma","code_information":[{"code":"4453260","type":"CDM"},{"code":"761","type":"RC"},{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":187,"gross_charge":220,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"28495 Fx Big Toe Clsd W Manipul","code_information":[{"code":"4453129","type":"CDM"},{"code":"761","type":"RC"},{"code":"28495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":187,"gross_charge":220,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"28515 Fx Toe Clsd W Manip Each","code_information":[{"code":"4453131","type":"CDM"},{"code":"761","type":"RC"},{"code":"28515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":187,"gross_charge":220,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"30300 Removal Fb Intranasal","code_information":[{"code":"4453146","type":"CDM"},{"code":"761","type":"RC"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":187,"gross_charge":220,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"Nasal Rapd Rhino 7.5cm Epistaxs","code_information":[{"code":"4273902","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273902","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":187,"gross_charge":220,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"Iodine, Ur Cvt","code_information":[{"code":"4302062","type":"CDM"},{"code":"301","type":"RC"},{"code":"83789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":185,"gross_charge":218,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"C. Diff Toxin(s) Assay Cvt","code_information":[{"code":"4300015","type":"CDM"},{"code":"306","type":"RC"},{"code":"87230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":184,"gross_charge":217,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Culture, Herpes Simplex /Typ Cvt","code_information":[{"code":"4302308","type":"CDM"},{"code":"309","type":"RC"},{"code":"87255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":184,"gross_charge":217,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Myeloperoxidase Antibody Cvt","code_information":[{"code":"4302759","type":"CDM"},{"code":"301","type":"RC"},{"code":"83876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":184,"gross_charge":217,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Sheet Bartn Trnsfr & Postitionr","code_information":[{"code":"4273962","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273962","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":184,"gross_charge":217,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Spine Thoracolumbar 2 Views","code_information":[{"code":"4330285-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":174,"maximum":184,"gross_charge":217,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Tibia/fibula 2 Views Left","code_information":[{"code":"4330220-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"X-ray Exam Chest 1 View","code_information":[{"code":"4330145-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Abdomen 1 View","code_information":[{"code":"4330103-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Ankle 2 Views Left","code_information":[{"code":"4330112-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Ankle 2 Views Right","code_information":[{"code":"4330111-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Ankle Complete Left","code_information":[{"code":"4330114-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Ankle Complete Right","code_information":[{"code":"4330113-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Calcaneous Min 2 Views Left","code_information":[{"code":"4330115-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Calcaneous Min 2 Views Right","code_information":[{"code":"4330118-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Chest 2 Views","code_information":[{"code":"4330149-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Clavicle Left","code_information":[{"code":"4330154-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Clavicle Right","code_information":[{"code":"4330155-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Elbow 2 Views Left","code_information":[{"code":"4330170-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Elbow 2 Views Right","code_information":[{"code":"4330169-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Elbow Min 3 Views Left","code_information":[{"code":"4330168-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Elbow Min 3 Views Right","code_information":[{"code":"4330167-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Facial Bones < 3 Views","code_information":[{"code":"4330172-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70140","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Femur 2 Views Left","code_information":[{"code":"4330176-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Femur 2 Views Right","code_information":[{"code":"4330177-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Finger Left","code_information":[{"code":"4330193-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Finger Right","code_information":[{"code":"4330194-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Foot 2 Views Left","code_information":[{"code":"4330186-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Foot 2 Views Right","code_information":[{"code":"4330187-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Foot Complete Left","code_information":[{"code":"4330188-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Foot Complete Right","code_information":[{"code":"4330189-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Forearm 2 Views Left","code_information":[{"code":"4330190-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Forearm 2 Views Right","code_information":[{"code":"4330191-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Hand Min 3 Views Left","code_information":[{"code":"4330198-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Hand Min 3 Views Right","code_information":[{"code":"4330199-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Hip 1 View Lt W/ Pelvis","code_information":[{"code":"4330208-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Hip 1 View Rt W/ Pelvis","code_information":[{"code":"4330207-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Hip 2-3 Views Lt W/ Pelvis","code_information":[{"code":"4330206-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Hip 2-3 Views Rt W/ Pelvis","code_information":[{"code":"4330205-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Humerus Min 2 Views Left","code_information":[{"code":"4330210-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Humerus Minimum 2 Views Right","code_information":[{"code":"4330211-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Knee 3 Views Left","code_information":[{"code":"4330223-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Knee 3 Views Right","code_information":[{"code":"4330222-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Knee One Or Two Views Left","code_information":[{"code":"4330216-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Knee One Or Two Views Right","code_information":[{"code":"4330217-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Knee Standing Ap Bilateral","code_information":[{"code":"4330238-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Mandible Partial Less Than 4 Views","code_information":[{"code":"4330224-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Neck Soft Tissue","code_information":[{"code":"4330231-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Sacrum And Coccyx","code_information":[{"code":"4330157-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Scapula Left","code_information":[{"code":"4330257-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Scapula Right","code_information":[{"code":"4330258-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Scolios Study","code_information":[{"code":"4330284-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72081","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Shoulder 1 View Left","code_information":[{"code":"4330262-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Shoulder 1 View Right","code_information":[{"code":"4330263-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Shoulder 2 Views Left","code_information":[{"code":"4330264-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Shoulder 2 Views Right","code_information":[{"code":"4330265-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Shoulder Complete Left","code_information":[{"code":"4330142-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Sinuses Paranasal < 3 Views","code_information":[{"code":"4330268-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Sinuses Paranasal Complete","code_information":[{"code":"4330267-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Spine 1 View Cervical","code_information":[{"code":"4330295-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Spine 1 View Lumbar","code_information":[{"code":"4330287-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Spine 1 View Thoracic","code_information":[{"code":"4330281-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Spine Cervical 2 Or 3 Views","code_information":[{"code":"4330279-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Tibia/fibula 2 Views Right","code_information":[{"code":"4330221-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Toes Left","code_information":[{"code":"4330306-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Toes Right","code_information":[{"code":"4330307-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Wrist 2 Views Left","code_information":[{"code":"4330320-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Wrist 2 Views Right","code_information":[{"code":"4330321-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Wrist Complete Left","code_information":[{"code":"4330322-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Wrist Complete Right","code_information":[{"code":"4330323-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Bd Dexa Vfa Only","code_information":[{"code":"4330502-TC","type":"CDM"},{"code":"329","type":"RC"},{"code":"77086","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Mandible Complete Minimum 4 Views","code_information":[{"code":"4330225-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Excision, Malignant Lesion, Trunk, Arms, Or Legs; 0.6 To 1.0 Cm Technical Charge","code_information":[{"code":"11601","type":"CDM"},{"code":"521","type":"RC"},{"code":"11601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":184,"gross_charge":216,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Ippe Welcome To Mc","code_information":[{"code":"G0402","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":183,"gross_charge":215,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"10120 Incision & Removal Of Foreign Body, Subcutaneous Tissues; Simple Charge","code_information":[{"code":"10120","type":"CDM"},{"code":"521","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":182,"gross_charge":214,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"11310 Shave (Epi)dermal Lesion, Single, Face/ears/eyelids/nose/lips/mucous Membrane; Diam 0.5cm>","code_information":[{"code":"11310","type":"CDM"},{"code":"521","type":"RC"},{"code":"11310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":182,"gross_charge":214,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"11401 Remove Lesion, Trunk/arm/leg .6 To 1.0 Cm Charge","code_information":[{"code":"11401","type":"CDM"},{"code":"521","type":"RC"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":182,"gross_charge":214,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"92610 Evaluation Of Oral And Pharyngeal Swallowing Function","code_information":[{"code":"4389001","type":"CDM"},{"code":"441","type":"RC"},{"code":"92610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":182,"gross_charge":214,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"92521 Eval Speech Fluency","code_information":[{"code":"4380011","type":"CDM"},{"code":"441","type":"RC"},{"code":"92521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":181,"gross_charge":213,"discounted_cash":160,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181}]}]},{"description":"Nasal Rapd Rhino 5.5cm Epistaxs","code_information":[{"code":"4273066","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273066","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":181,"gross_charge":213,"discounted_cash":160,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181}]}]},{"description":"99281- Ed Visit Level 1 Ed Facility Charge Ticket","code_information":[{"code":"4453001","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":179,"gross_charge":211,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Dressing Silver Sugical Aquacel 3 1/2 X14","code_information":[{"code":"4273136","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273136","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":179,"gross_charge":211,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Immunofixation, Ser Cvt","code_information":[{"code":"4302423","type":"CDM"},{"code":"302","type":"RC"},{"code":"86334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":179,"gross_charge":211,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Dressing Vac Sm Black Foam","code_information":[{"code":"4273154","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273154","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":179,"gross_charge":210,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Bordetella Pertussis","code_information":[{"code":"4300515","type":"CDM"},{"code":"306","type":"RC"},{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":179,"gross_charge":210,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Chlamydophila Pneumoniae","code_information":[{"code":"4300811","type":"CDM"},{"code":"306","type":"RC"},{"code":"87486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":179,"gross_charge":210,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Mycoplasma Pneumoniae","code_information":[{"code":"4300812","type":"CDM"},{"code":"306","type":"RC"},{"code":"87581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":179,"gross_charge":210,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Awv Mc Initial Visit","code_information":[{"code":"G0438","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":179,"gross_charge":210,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"97602 Pt Debridement-non Selective","code_information":[{"code":"4429028","type":"CDM"},{"code":"421","type":"RC"},{"code":"97602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":179,"gross_charge":210,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Pt Wound Care Non Selective Chargept Wound Care Non Selective Charge","code_information":[{"code":"4423522","type":"CDM"},{"code":"421","type":"RC"},{"code":"97602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":179,"gross_charge":210,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Hemostasis Surgicel","code_information":[{"code":"4273224","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273224","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":178,"gross_charge":209,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Splint Leg Lrg Shrt Post","code_information":[{"code":"4273925","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273925","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":177,"gross_charge":208,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Electrode Aed Pedi Zoll","code_information":[{"code":"4273662","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273662","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":177,"gross_charge":208,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Kappa/lambda Lite Chains,ser Cvt","code_information":[{"code":"4302174","type":"CDM"},{"code":"302","type":"RC"},{"code":"86335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":177,"gross_charge":208,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"11403 Remove Lesion, Trunk/arm/leg 2.1 To 3.0 Cm Charge","code_information":[{"code":"11403","type":"CDM"},{"code":"521","type":"RC"},{"code":"11403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":177,"gross_charge":208,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"12020 Treatment, Superficial Wound Dehiscence; Simple Closure","code_information":[{"code":"12020","type":"CDM"},{"code":"521","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":177,"gross_charge":208,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"46320 Enucleation Or Excise Of Ext Thrombotic Hemorrhoid Charge","code_information":[{"code":"46320","type":"CDM"},{"code":"521","type":"RC"},{"code":"46320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":177,"gross_charge":208,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Op Visit Level Ii","code_information":[{"code":"4473031","type":"CDM"},{"code":"761","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":174,"gross_charge":205,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Vitamin D,1,25-dihydroxy Cvt","code_information":[{"code":"4302304","type":"CDM"},{"code":"301","type":"RC"},{"code":"82652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":174,"gross_charge":205,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Room/bed: Observation 1st Hour","code_information":[{"code":"4460001","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":174,"gross_charge":205,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"97598 Selective Debridement >20cm Charge","code_information":[{"code":"4429027","type":"CDM"},{"code":"421","type":"RC"},{"code":"97598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":163,"maximum":173,"gross_charge":204,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"Selective Debridement Addition Charge","code_information":[{"code":"4423509","type":"CDM"},{"code":"421","type":"RC"},{"code":"97598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":163,"maximum":173,"gross_charge":204,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"Chest Drain Drysuction Water Seal Set","code_information":[{"code":"4273249","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273249","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":163,"maximum":173,"gross_charge":204,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"94618pulmonary Stress Testing (Eg, 6-minute Walk Test), Including Measurement Of Heart Rate, Oxim","code_information":[{"code":"44194618","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":173,"gross_charge":203,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"Destruct;benign Les/1st","code_information":[{"code":"4453073","type":"CDM"},{"code":"450","type":"RC"},{"code":"17000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":173,"gross_charge":203,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"41800 Drain Absc Cyst Hematma Dental Structures","code_information":[{"code":"44541800","type":"CDM"},{"code":"41800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":173,"gross_charge":203,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"99491chronic Care Management, 30 Minutes","code_information":[{"code":"99491","type":"CDM"},{"code":"521","type":"RC"},{"code":"99491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":171,"gross_charge":201,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171}]}]},{"description":"Bill Irradiation","code_information":[{"code":"4300254","type":"CDM"},{"code":"300","type":"RC"},{"code":"86945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":170,"gross_charge":200,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Splint Leg Md Short Posti","code_information":[{"code":"4273926","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273926","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":170,"gross_charge":200,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Group A Strep (Pcr)","code_information":[{"code":"4300017","type":"CDM"},{"code":"306","type":"RC"},{"code":"87651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":168,"gross_charge":198,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"H. Pylori Ag, Stool By Eia Cvt","code_information":[{"code":"4302333","type":"CDM"},{"code":"306","type":"RC"},{"code":"87338","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":168,"gross_charge":198,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"90698 Pentacel Vaccine (Dtap-hib-ipv)","code_information":[{"code":"90698","type":"CDM"},{"code":"636","type":"RC"},{"code":"90698","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":168,"gross_charge":198,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Chest Drain Heimlich Valv","code_information":[{"code":"4273217","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273217","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":168,"gross_charge":198,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Airtraq Sz 1 Video Intubation Unit","code_information":[{"code":"4273105","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273105","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":168,"gross_charge":198,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Incise Ex Thromb Hemorhoi","code_information":[{"code":"4453169","type":"CDM"},{"code":"450","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":167,"gross_charge":196,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167}]}]},{"description":"Vitamin E (Tocopherol) Cvt","code_information":[{"code":"4302698","type":"CDM"},{"code":"301","type":"RC"},{"code":"84446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":167,"gross_charge":196,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167}]}]},{"description":"Vitamin K Cvt","code_information":[{"code":"4302699","type":"CDM"},{"code":"301","type":"RC"},{"code":"84597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":167,"gross_charge":196,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167}]}]},{"description":"Initial new patient preventative medicine evaluation (18-39 years)","code_information":[{"code":"99385-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99385","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":157,"maximum":167,"gross_charge":196,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167}]}]},{"description":"17360 Chemical Exfoliation For Acne (Eg. Acne Paste Acid)","code_information":[{"code":"17360","type":"CDM"},{"code":"521","type":"RC"},{"code":"17360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":166,"gross_charge":195,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"58300 Insertion Of Intrauterine Device","code_information":[{"code":"58300","type":"CDM"},{"code":"521","type":"RC"},{"code":"58300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":166,"gross_charge":195,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Ex Ben Les Fce/er/ns/lip","code_information":[{"code":"11440","type":"CDM"},{"code":"521","type":"RC"},{"code":"11440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":166,"gross_charge":195,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Subseq Obs Care Level Iii Charge","code_information":[{"code":"4447113-AQ","type":"CDM"},{"code":"99226","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":156,"maximum":166,"gross_charge":195,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Suct Cannistr Neg Woundvac","code_information":[{"code":"4273252","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273252","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":165,"gross_charge":194,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165}]}]},{"description":"99396 Preventive Medicine 40-64 Years Established","code_information":[{"code":"99396-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99396","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":155,"maximum":165,"gross_charge":194,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165}]}]},{"description":"99316 Discharge Swingbed >30min","code_information":[{"code":"99316-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99316","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":154,"maximum":164,"gross_charge":193,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164}]}]},{"description":"Electrode Physio Lf/pk Adult Defib","code_information":[{"code":"4273628","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273628","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":164,"gross_charge":193,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164}]}]},{"description":"Splint Leg Sm Hip Posterior","code_information":[{"code":"4273931","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273931","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":162,"gross_charge":190,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Ref Antibody Id","code_information":[{"code":"4302189","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":160,"gross_charge":188,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Cyclic Citrulline Peptide Igg Cvt","code_information":[{"code":"4302131","type":"CDM"},{"code":"302","type":"RC"},{"code":"86200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":160,"gross_charge":188,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Preventive Medicine 18-39 Years Established","code_information":[{"code":"99395-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99395","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":150,"maximum":159,"gross_charge":187,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159}]}]},{"description":"Tray Central Ven Cath 7fr 8","code_information":[{"code":"4273504","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273504","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":158,"gross_charge":186,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Op Visit Level I","code_information":[{"code":"4473029","type":"CDM"},{"code":"761","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":158,"gross_charge":186,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Boot Podus Off The Heel Protector","code_information":[{"code":"4273141","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273141","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":156,"gross_charge":184,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"98926 Omt 3-4 Body Regions Ed Charge","code_information":[{"code":"44598926","type":"CDM"},{"code":"450","type":"RC"},{"code":"98926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":156,"gross_charge":184,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"Vitamin B6, Plasma Cvt","code_information":[{"code":"4302327","type":"CDM"},{"code":"301","type":"RC"},{"code":"84207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":156,"gross_charge":183,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"Initial Obs Care Level I Charge","code_information":[{"code":"4447108-AQ","type":"CDM"},{"code":"99218","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":146,"maximum":156,"gross_charge":183,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"Estradiol, Total Cvt","code_information":[{"code":"4302332","type":"CDM"},{"code":"301","type":"RC"},{"code":"82670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":155,"gross_charge":182,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"11402 Remove Lesion, Trunk/arm/leg 1.1 To 2.0 Cm Charge","code_information":[{"code":"11402","type":"CDM"},{"code":"521","type":"RC"},{"code":"11402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":155,"gross_charge":182,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"11981-insertion, Non-biodegradable Drug Delivery Implant [Cchd]","code_information":[{"code":"11981","type":"CDM"},{"code":"521","type":"RC"},{"code":"11981","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":155,"gross_charge":182,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"12011 Repair Simple  Face, Ears, Eyelids, Nose, Lips And/or Mucous Membranes; 2.5 Cm > Charge","code_information":[{"code":"12011","type":"CDM"},{"code":"521","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":155,"gross_charge":182,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Excision, Benign Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm Technical Charge","code_information":[{"code":"11421","type":"CDM"},{"code":"521","type":"RC"},{"code":"11421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":155,"gross_charge":182,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"11400 Remove Lesion, Trunk/arm/leg <.5 Cm Charge","code_information":[{"code":"11400","type":"CDM"},{"code":"521","type":"RC"},{"code":"11400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":154,"gross_charge":181,"discounted_cash":136,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}]},{"description":"Xr Ac Joints Bilateral","code_information":[{"code":"4330108-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Xr Nasal Bones Minimum 3 Views","code_information":[{"code":"4330229-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Xr Sternum Minimum 2 Views","code_information":[{"code":"4330303-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Boot Hi-top Sm Walker","code_information":[{"code":"4273219","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273219","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"90632 Hepatitis A Vaccine, Adult Dosage, For Intramuscular Use","code_information":[{"code":"90632","type":"CDM"},{"code":"636","type":"RC"},{"code":"90632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"97597 Sel Debridement Charge","code_information":[{"code":"CP17667781912189702","type":"CDM"},{"code":"420","type":"RC"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"97597 Selective Debridement <20cm Charge","code_information":[{"code":"4429026","type":"CDM"},{"code":"421","type":"RC"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Selective Debridement Charge","code_information":[{"code":"4423508","type":"CDM"},{"code":"420","type":"RC"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Collar Stifnec Adult Cervical","code_information":[{"code":"4273840","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":153,"gross_charge":180,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Oxygen Acapella Vibrapep Unit","code_information":[{"code":"4273989","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273989","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":152,"gross_charge":179,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Heel Protector Soft","code_information":[{"code":"4273631","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273631","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":151,"gross_charge":178,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"29086 Casting Thumb Spica","code_information":[{"code":"4453255","type":"CDM"},{"code":"761","type":"RC"},{"code":"29086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":151,"gross_charge":178,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"29200 Strapping Thorax  Chest.","code_information":[{"code":"4453135","type":"CDM"},{"code":"761","type":"RC"},{"code":"29200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":151,"gross_charge":178,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"29540 Strapping Ankl & Or Foot","code_information":[{"code":"4453144","type":"CDM"},{"code":"761","type":"RC"},{"code":"29540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":151,"gross_charge":178,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"29799 Strapping Low Back.","code_information":[{"code":"4453136","type":"CDM"},{"code":"761","type":"RC"},{"code":"29799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":151,"gross_charge":178,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"Unna Boot Application Tech Charge","code_information":[{"code":"44729580","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":151,"gross_charge":178,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"10060 Tr I&d Of Absxess Smpl/sngl Charge","code_information":[{"code":"CP17667781912956724","type":"CDM"},{"code":"CP17667781912956724","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":151,"gross_charge":178,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"Dressing Vac Foam Silvr /Set","code_information":[{"code":"4273213","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273213","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":149,"gross_charge":175,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"Hemostatis Celox Rapid Ribbon 1 X 5'","code_information":[{"code":"4273028","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":149,"gross_charge":175,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"Electrode Aed Mcd Adult Powerheart Zoll (Mcd)","code_information":[{"code":"A4556","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":139,"maximum":148,"gross_charge":174,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"Dressing Vac Lg Black Foam","code_information":[{"code":"4273212","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273212","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":147,"gross_charge":173,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"17-hydroxyprogesterone, Urine Cvt","code_information":[{"code":"4302415","type":"CDM"},{"code":"301","type":"RC"},{"code":"83498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":147,"gross_charge":173,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Vitamin D Total 25-hydroxy Cvt","code_information":[{"code":"4302362","type":"CDM"},{"code":"301","type":"RC"},{"code":"82306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":147,"gross_charge":173,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"99203-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99203","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":138,"maximum":147,"gross_charge":173,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"99304 Initial Swingbed Level1","code_information":[{"code":"99304-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99304","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":138,"maximum":147,"gross_charge":173,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Trichomonas Vaginalis Pcr Cvt","code_information":[{"code":"4302774","type":"CDM"},{"code":"306","type":"RC"},{"code":"87661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":146,"gross_charge":172,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146}]}]},{"description":"99489complex Chronic Care Management; Each Additional 30 Minutes","code_information":[{"code":"99489","type":"CDM"},{"code":"521","type":"RC"},{"code":"99489","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":145,"gross_charge":171,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Tissue Transglutaminase, Igg Cvt","code_information":[{"code":"4302136","type":"CDM"},{"code":"301","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":145,"gross_charge":170,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"97168 Ot Re-eval Charge","code_information":[{"code":"4409023","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":145,"gross_charge":170,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Ot Reevaluationreevaluation Charge","code_information":[{"code":"4400004","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":145,"gross_charge":170,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"41899 Unlstd Proce Dental Struc","code_information":[{"code":"4456488","type":"CDM"},{"code":"761","type":"RC"},{"code":"41899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":144,"gross_charge":169,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"42000 Drainage Of Abscess Palat","code_information":[{"code":"4456487","type":"CDM"},{"code":"761","type":"RC"},{"code":"42000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":144,"gross_charge":169,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"17111 Wart Destruct 15or>les","code_information":[{"code":"17111","type":"CDM"},{"code":"521","type":"RC"},{"code":"17111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":144,"gross_charge":169,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"30300 Remv Nasal Foreign Bdy","code_information":[{"code":"30300","type":"CDM"},{"code":"521","type":"RC"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":144,"gross_charge":169,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"I&d Of Bartholin's Gland Abscess Charge","code_information":[{"code":"56420","type":"CDM"},{"code":"521","type":"RC"},{"code":"56420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":144,"gross_charge":169,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Repair Simple Scalp, Neck, Axillae, Ext Genital","code_information":[{"code":"12001","type":"CDM"},{"code":"521","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":144,"gross_charge":169,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"96367 Iv Infusion, Addl Sequential Infusion, 1st Hour-hosp","code_information":[{"code":"4455084","type":"CDM"},{"code":"761","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":143,"gross_charge":168,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"96372 Injection Admin, Sq Or Im- Hosp","code_information":[{"code":"4455086","type":"CDM"},{"code":"761","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":143,"gross_charge":168,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"Inj Ther/prop/diag Im/sc","code_information":[{"code":"4475086","type":"CDM"},{"code":"761","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":143,"gross_charge":168,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"Iv Infus Ther Seq 1st Hr","code_information":[{"code":"4475084","type":"CDM"},{"code":"761","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":143,"gross_charge":168,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"90471 Immun Admin 1st","code_information":[{"code":"4455095","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":142,"gross_charge":167,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"99309 Subsequent Swingbed Level3","code_information":[{"code":"99309-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99309","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":134,"maximum":142,"gross_charge":167,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"99384 Preventive Medicine 12-17 Years New","code_information":[{"code":"99384-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99384","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":134,"maximum":142,"gross_charge":167,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Chromatin Antibody Cvt","code_information":[{"code":"4302051","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":141,"gross_charge":166,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Nbs (Private) Pku","code_information":[{"code":"4300650","type":"CDM"},{"code":"301","type":"RC"},{"code":"84030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":141,"gross_charge":166,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Testosterone, Total","code_information":[{"code":"4302682","type":"CDM"},{"code":"301","type":"RC"},{"code":"84403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Hla-b27 Cvt","code_information":[{"code":"4302490","type":"CDM"},{"code":"302","type":"RC"},{"code":"86812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Testosterone, Total Cvt","code_information":[{"code":"4302684","type":"CDM"},{"code":"301","type":"RC"},{"code":"84403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"10060 Drain Skin Abscess, Simple/single Charge","code_information":[{"code":"10060","type":"CDM"},{"code":"521","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"10080 Incision, Drainage; Pilonidal Cyst; Simple","code_information":[{"code":"10080","type":"CDM"},{"code":"521","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"11300 Shvng Epdrml Les Sngl Tal","code_information":[{"code":"11300","type":"CDM"},{"code":"521","type":"RC"},{"code":"11300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Nipple Exploration.excision","code_information":[{"code":"10140","type":"CDM"},{"code":"521","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Scd Garmnt Calf  (Med)","code_information":[{"code":"4273377","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273377","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Scd Garmnt Calf   (Lrg)","code_information":[{"code":"4273655","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273655","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":140,"gross_charge":165,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Collect Bld Ven Acc Device Charge","code_information":[{"code":"4453158","type":"CDM"},{"code":"761","type":"RC"},{"code":"36591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":138,"gross_charge":162,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Catecholamines, Fractionated Cvt","code_information":[{"code":"4302214","type":"CDM"},{"code":"301","type":"RC"},{"code":"82384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":137,"gross_charge":161,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Catecholamines, Ur 24hr Cvt","code_information":[{"code":"4302212","type":"CDM"},{"code":"301","type":"RC"},{"code":"82384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":137,"gross_charge":161,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Tray Central Ven Cath 4fr","code_information":[{"code":"4273692","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273692","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":137,"gross_charge":161,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Lens Morgan Each","code_information":[{"code":"4273441","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273441","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":135,"gross_charge":159,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Mmr Measles/mumps/rubella Virus Vaccine Poc","code_information":[{"code":"90707","type":"CDM"},{"code":"636","type":"RC"},{"code":"90707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":135,"gross_charge":159,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Estriol","code_information":[{"code":"4302339","type":"CDM"},{"code":"301","type":"RC"},{"code":"82677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":133,"gross_charge":157,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Pt Re-evaluationreevaluation Charge","code_information":[{"code":"4423071","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":133,"gross_charge":157,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Pt Re-evaluation Charge","code_information":[{"code":"4429022","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":133,"gross_charge":157,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Chromium, Plasma Cvt","code_information":[{"code":"4302235","type":"CDM"},{"code":"301","type":"RC"},{"code":"82495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"96374 Inj Ivp Single/init Drug","code_information":[{"code":"CP17667781912239709","type":"CDM"},{"code":"CP17667781912239709","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Dressing Vac Veralink Cassette","code_information":[{"code":"4273449","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273449","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Electrode Aed Adult Zoll Stat-pad Ii","code_information":[{"code":"4273113","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273113","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"11420 Remove Lesion, Scalp/neck/hand/foot <0.5 Cm Charge","code_information":[{"code":"11420","type":"CDM"},{"code":"521","type":"RC"},{"code":"11420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"28490 Closed Trtmt Of Fx Great Toe, Phalanx Or Phalanges; W/o Manipulation Charge","code_information":[{"code":"28490","type":"CDM"},{"code":"521","type":"RC"},{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Destruct Lesion 1st","code_information":[{"code":"17000","type":"CDM"},{"code":"521","type":"RC"},{"code":"17000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Psychotherapy, 60 Minutes With Patient When Performed As An Evaluation And Mamnagement Service","code_information":[{"code":"90838-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90838","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Gastric/lavage 18fr E-z","code_information":[{"code":"4273634","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273634","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Splint Leg Sm Short Posti","code_information":[{"code":"4273927","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273927","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":133,"gross_charge":156,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Hiv 1&2 Ag & Ab Cvt","code_information":[{"code":"4302438","type":"CDM"},{"code":"306","type":"RC"},{"code":"87389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":131,"gross_charge":154,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"West Nile Virus Ab, Igg,m Cvt","code_information":[{"code":"4302742","type":"CDM"},{"code":"302","type":"RC"},{"code":"86788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":130,"gross_charge":153,"discounted_cash":115,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Xr Sacroiliac Joints 1 Or 2 Views","code_information":[{"code":"4330259-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72200","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":122,"maximum":130,"gross_charge":153,"discounted_cash":115,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Port Flush Charge","code_information":[{"code":"4476000","type":"CDM"},{"code":"761","type":"RC"},{"code":"96523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":129,"gross_charge":152,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Poliovirus Vacc. Ipv Inactivated","code_information":[{"code":"90713","type":"CDM"},{"code":"636","type":"RC"},{"code":"90713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":129,"gross_charge":152,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"28510 Closed Trtmt Of Fx, Phalanx Or Phalanges, Other Than Great To E; W/manipulation, Each Charge","code_information":[{"code":"28510","type":"CDM"},{"code":"521","type":"RC"},{"code":"28510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":129,"gross_charge":152,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Dressing Vac Med Black Foam","code_information":[{"code":"4273251","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273251","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":128,"gross_charge":151,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Dressing Vac White Foam Small","code_information":[{"code":"4273357","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273357","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":128,"gross_charge":151,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Meter Dose Inhaler (Mdi) Instruction","code_information":[{"code":"4413011","type":"CDM"},{"code":"412","type":"RC"},{"code":"94664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":128,"gross_charge":150,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"99497 Acp Swingbed","code_information":[{"code":"99497-AM","type":"CDM"},{"code":"524","type":"RC"},{"code":"99497","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":120,"maximum":128,"gross_charge":150,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Awv Mc Subsequent","code_information":[{"code":"G0439","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":128,"gross_charge":150,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Family psychotherapy, including patient, 50 min","code_information":[{"code":"90847","type":"CDM"},{"code":"900","type":"RC"},{"code":"90847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":127,"gross_charge":149,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Knee/immob/med-20","code_information":[{"code":"4273591","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":127,"gross_charge":149,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Cpap Heated Tubing Luna 6ft 22mm Cuff","code_information":[{"code":"4273120","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273120","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":127,"gross_charge":149,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"H. Pylori Stool Ag","code_information":[{"code":"4300333","type":"CDM"},{"code":"306","type":"RC"},{"code":"87338","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":127,"gross_charge":149,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"99214 Office/op Established  Visit Level 4","code_information":[{"code":"99214-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99214","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":119,"maximum":127,"gross_charge":149,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"69209- Removal Impacted Cerumen Requiring Lavage/irrigation, Unilateral","code_information":[{"code":"44569209","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":127,"gross_charge":149,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine And Poliovirus Vaccine, Inactivated (Dtap-i","code_information":[{"code":"90696","type":"CDM"},{"code":"636","type":"RC"},{"code":"90696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":127,"gross_charge":149,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"11200 Removal Of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up To & W/15 Lesions Charge","code_information":[{"code":"11200","type":"CDM"},{"code":"521","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":126,"gross_charge":148,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Chronic Care Management","code_information":[{"code":"99490","type":"CDM"},{"code":"521","type":"RC"},{"code":"99490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":125,"gross_charge":147,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Soluble Liver Antigen Auto Ab Cvt","code_information":[{"code":"4302471","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":125,"gross_charge":147,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"91321 Modena Covid-19 Vaccine(mrna) 6 Month-11 Years Sdv 25mcg/0.25ml","code_information":[{"code":"91321","type":"CDM"},{"code":"636","type":"RC"},{"code":"91321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":124,"gross_charge":146,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"91322 Modena Covid-19 Vaccine(mrna) 12 Years And Older Pfs 50 Mcg/0.5 Ml","code_information":[{"code":"91322","type":"CDM"},{"code":"636","type":"RC"},{"code":"91322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":124,"gross_charge":146,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Clinic Ekg Poc","code_information":[{"code":"93005","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":124,"gross_charge":146,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Bladder Scan Pmho","code_information":[{"code":"44551798","type":"CDM"},{"code":"450","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":124,"gross_charge":146,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Cv Ekg Exam Only","code_information":[{"code":"4733001","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":124,"gross_charge":146,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"99404 Preventive Medicine Counseling, 60 Min","code_information":[{"code":"99404-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99404","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":115,"maximum":122,"gross_charge":144,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Counseling Risk Factor Intervention 60 Min","code_information":[{"code":"48099404","type":"CDM"},{"code":"521","type":"RC"},{"code":"99404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":122,"gross_charge":144,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Family psychotherapy, not including patient, 50 min","code_information":[{"code":"90846","type":"CDM"},{"code":"900","type":"RC"},{"code":"90846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":122,"gross_charge":144,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Stool Shiga Toxin Cvt","code_information":[{"code":"4302006","type":"CDM"},{"code":"306","type":"RC"},{"code":"87427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":120,"gross_charge":141,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Xr Ue Infant Min 2 Views Left","code_information":[{"code":"4330209-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":113,"maximum":120,"gross_charge":141,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Xr Ue Infant Min 2 Views Right","code_information":[{"code":"4330342-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":113,"maximum":120,"gross_charge":141,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"99437 Chronic Care Management Services, Each Additional 30 Min","code_information":[{"code":"99437","type":"CDM"},{"code":"521","type":"RC"},{"code":"99437","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":119,"gross_charge":140,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119}]}]},{"description":"Plasma Renin Activity Cvt","code_information":[{"code":"4302631","type":"CDM"},{"code":"301","type":"RC"},{"code":"84244","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":119,"gross_charge":140,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119}]}]},{"description":"99394 Preventive Medicine 12-17 Years Established","code_information":[{"code":"99394-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99394","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":111,"maximum":118,"gross_charge":139,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118}]}]},{"description":"Drain Sublungual Hematoma","code_information":[{"code":"4453026","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":117,"gross_charge":138,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"29240 Strapping  Shoulder.","code_information":[{"code":"4453137","type":"CDM"},{"code":"761","type":"RC"},{"code":"29240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":117,"gross_charge":138,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"29530 Strapping Knee.","code_information":[{"code":"4453143","type":"CDM"},{"code":"761","type":"RC"},{"code":"29530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":117,"gross_charge":138,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Dhea Sulfate Cvt","code_information":[{"code":"4302302","type":"CDM"},{"code":"301","type":"RC"},{"code":"82627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":117,"gross_charge":138,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Bill Only Antigen Testing","code_information":[{"code":"4300199","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":116,"gross_charge":136,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116}]}]},{"description":"Progesterone Cvt","code_information":[{"code":"4302613","type":"CDM"},{"code":"301","type":"RC"},{"code":"84144","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":116,"gross_charge":136,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116}]}]},{"description":"Subseq Obs Care Level Ii Charge","code_information":[{"code":"4447112-AQ","type":"CDM"},{"code":"99225","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":109,"maximum":116,"gross_charge":136,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116}]}]},{"description":"Tourniquet Combat (Ems) Tourniquet","code_information":[{"code":"4273827","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273827","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":116,"gross_charge":136,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116}]}]},{"description":"Tray Thora / Paracentesis","code_information":[{"code":"4273116","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273116","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Cpap/bipap Mask Med. Full Face","code_information":[{"code":"4273879","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273879","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Ca 125 Antigen Cvt","code_information":[{"code":"4302208","type":"CDM"},{"code":"302","type":"RC"},{"code":"86304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Magnesium, Rbc Cvt","code_information":[{"code":"4302010","type":"CDM"},{"code":"301","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Xr Child  Nose-rectum For Fb","code_information":[{"code":"4330102-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Xr Femur 1 View Left","code_information":[{"code":"4330324-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Xr Femur 1 View Right","code_information":[{"code":"4330175-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Xr Le Infant Min 2 Views Left","code_information":[{"code":"4330227-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Xr Le Infant Min 2 Views Right","code_information":[{"code":"4330343-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Cpap/bipap Mask Lg Full Face","code_information":[{"code":"4273810","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273810","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Hemostatis Celox Gauze Roll 3 X 5","code_information":[{"code":"4273031","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"99315 Discharge Swingbed <30min","code_information":[{"code":"99315-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99315","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":108,"maximum":115,"gross_charge":135,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Arterial Blood Gas Standard","code_information":[{"code":"4300139","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":114,"gross_charge":134,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Venous Blood Gas Standard","code_information":[{"code":"4300137","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":114,"gross_charge":134,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"C- Peptide Cvt","code_information":[{"code":"4302204","type":"CDM"},{"code":"301","type":"RC"},{"code":"84681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":113,"gross_charge":133,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Ca 19-9 Cvt","code_information":[{"code":"4302209","type":"CDM"},{"code":"302","type":"RC"},{"code":"86301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":113,"gross_charge":133,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Antibody Screen Gel","code_information":[{"code":"4300253","type":"CDM"},{"code":"300","type":"RC"},{"code":"86885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":112,"gross_charge":132,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Ref Antibody Screen","code_information":[{"code":"4302911","type":"CDM"},{"code":"302","type":"RC"},{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":112,"gross_charge":132,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"10160 Puncture Aspirtn Of Abscess, Hematoma, Bulla, Or Cyst Charge","code_information":[{"code":"10160","type":"CDM"},{"code":"521","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":112,"gross_charge":132,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Debridement Of Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface Technical Charge","code_information":[{"code":"11000","type":"CDM"},{"code":"521","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":112,"gross_charge":132,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Quikclot Pads 4x4  (Ems)","code_information":[{"code":"4273796","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273796","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":111,"gross_charge":131,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"11730 Avulsion Of Nail Plate, Partial Or Complete, Simple; Single Charge","code_information":[{"code":"11730","type":"CDM"},{"code":"521","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":111,"gross_charge":130,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Control Of Nosebleedclinic","code_information":[{"code":"30901","type":"CDM"},{"code":"521","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":111,"gross_charge":130,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Dressings And/or Debridement Of Partial-thickness Burns, Initial Or Subsequent; Medium (Eg, Whole Fa","code_information":[{"code":"16025","type":"CDM"},{"code":"521","type":"RC"},{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":111,"gross_charge":130,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Endometrial Bx Wo Cervical Dilation","code_information":[{"code":"58100","type":"CDM"},{"code":"521","type":"RC"},{"code":"58100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":111,"gross_charge":130,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Incise Ext Hemorrhoid- Clinic","code_information":[{"code":"46083","type":"CDM"},{"code":"521","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":111,"gross_charge":130,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Glomerular Basement Membran Ab Cvt","code_information":[{"code":"4302041","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":109,"gross_charge":128,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Hepatitis B Vaccine, Adult","code_information":[{"code":"90746","type":"CDM"},{"code":"636","type":"RC"},{"code":"90746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":109,"gross_charge":128,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"99308 Subsequent Swingbed Level2","code_information":[{"code":"99308","type":"CDM"},{"code":"524","type":"RC"},{"code":"99308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":108,"gross_charge":127,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"69210 Removal Impacted Cerumen, Requiring Instrumentation","code_information":[{"code":"69210","type":"CDM"},{"code":"521","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":108,"gross_charge":127,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"99308 Subsequent Swing Bed Level 2","code_information":[{"code":"4447124-AQ","type":"CDM"},{"code":"524","type":"RC"},{"code":"99308","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":102,"maximum":108,"gross_charge":127,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"98925 Omt 1-2 Body Regions Ed Charge","code_information":[{"code":"44598925","type":"CDM"},{"code":"450","type":"RC"},{"code":"98925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":108,"gross_charge":127,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Air-q Sp3g Size 5","code_information":[{"code":"4273911","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273911","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":108,"gross_charge":127,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Insulin Autoantibody Cvt","code_information":[{"code":"4302914","type":"CDM"},{"code":"302","type":"RC"},{"code":"86337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":107,"gross_charge":126,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Prolactin Cvt","code_information":[{"code":"4302615","type":"CDM"},{"code":"301","type":"RC"},{"code":"84146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":107,"gross_charge":126,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"96411 Chemo/cmplx Ivp Ea Add'l","code_information":[{"code":"4455091","type":"CDM"},{"code":"335","type":"RC"},{"code":"96411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":106,"gross_charge":125,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"96417 Chemo/cmplx Ea Ad Seq Inf","code_information":[{"code":"4455094","type":"CDM"},{"code":"335","type":"RC"},{"code":"96417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":106,"gross_charge":125,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Ostomy Odor Elim Gtts","code_information":[{"code":"4273901","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273901","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":106,"gross_charge":125,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Hemostatis Celox Granules 15 Gram Packet","code_information":[{"code":"4273026","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":106,"gross_charge":125,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Carcinoembryonic  Ag Cvt","code_information":[{"code":"4302215","type":"CDM"},{"code":"301","type":"RC"},{"code":"82378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":105,"gross_charge":123,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Office/op New Visit Level 2 99202","code_information":[{"code":"99202-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99202","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":98,"maximum":105,"gross_charge":123,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Levetiracetam Cvt","code_information":[{"code":"4302448","type":"CDM"},{"code":"301","type":"RC"},{"code":"80177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":104,"gross_charge":122,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Air-q Airway Size 0","code_information":[{"code":"4273069","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273069","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":104,"gross_charge":122,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Air-q Airway Size 0.5","code_information":[{"code":"4273067","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273067","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":104,"gross_charge":122,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Cyclosporine, Monoclonal Cvt","code_information":[{"code":"4302726","type":"CDM"},{"code":"301","type":"RC"},{"code":"80158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":103,"gross_charge":121,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Hemostatis Celox Applicator/plunger 6 Grams","code_information":[{"code":"4273027","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":103,"gross_charge":121,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Humidifier/vaporizr Cool","code_information":[{"code":"4273997","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273997","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":103,"gross_charge":121,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"X-Ray of lower back","code_information":[{"code":"4330293","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":102,"gross_charge":120,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Erythropoietin Cvt","code_information":[{"code":"4302330","type":"CDM"},{"code":"301","type":"RC"},{"code":"82668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":102,"gross_charge":120,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"76942 Us Guidance For Injection","code_information":[{"code":"49076942","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":102,"gross_charge":120,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Us Guidance For Asp/inj/biop Exam Only","code_information":[{"code":"49076942-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":96,"maximum":102,"gross_charge":120,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Follicle Stim Horm Cvt","code_information":[{"code":"4302349","type":"CDM"},{"code":"301","type":"RC"},{"code":"83001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":101,"gross_charge":119,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"99490 Ccmccmg Code Charge","code_information":[{"code":"G0511","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":101,"gross_charge":119,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Dressing Multidex Gel 3oz","code_information":[{"code":"4273679","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273679","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":100,"gross_charge":118,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Ea Add Nail Plate","code_information":[{"code":"4453025","type":"CDM"},{"code":"450","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":100,"gross_charge":118,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Luteinizing  Hormone Cvt","code_information":[{"code":"4302456","type":"CDM"},{"code":"301","type":"RC"},{"code":"83002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":100,"gross_charge":118,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"65205 Remove Fb Eye;conjuct Sfc","code_information":[{"code":"4453176","type":"CDM"},{"code":"761","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":100,"gross_charge":118,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Psychotherapy, 45 Minutes With Patient When Performed As An Evaluation And Mamnagement Service","code_information":[{"code":"90836-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90836","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":94,"maximum":100,"gross_charge":118,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"4302620","type":"CDM"},{"code":"301","type":"RC"},{"code":"84154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":99,"gross_charge":117,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Anca Screen Cvt","code_information":[{"code":"4302459","type":"CDM"},{"code":"302","type":"RC"},{"code":"86021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":99,"gross_charge":117,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Islet Cell Antibody Scrn W/tit Cvt","code_information":[{"code":"4302427","type":"CDM"},{"code":"302","type":"RC"},{"code":"86341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":99,"gross_charge":117,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"4300619","type":"CDM"},{"code":"301","type":"RC"},{"code":"84153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":99,"gross_charge":117,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Psa Screen","code_information":[{"code":"4300626","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":99,"gross_charge":117,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Surg Path Level Iv Bill Only","code_information":[{"code":"4306439","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":99,"gross_charge":117,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Strep Latex Charge","code_information":[{"code":"4300560","type":"CDM"},{"code":"306","type":"RC"},{"code":"87147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":99,"gross_charge":117,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Rubeola (Measles) Ab, Igm  Cvt","code_information":[{"code":"43086765","type":"CDM"},{"code":"302","type":"RC"},{"code":"86765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":99,"gross_charge":117,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Complement,ch50 Total Cvt","code_information":[{"code":"4302248","type":"CDM"},{"code":"302","type":"RC"},{"code":"86162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":99,"gross_charge":116,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Prot Electrophoresis Ur 24 Cvt","code_information":[{"code":"4302331","type":"CDM"},{"code":"301","type":"RC"},{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":99,"gross_charge":116,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"99457 Telehealth Rem Monitor Physiol Monitor 20 Minute","code_information":[{"code":"99457","type":"CDM"},{"code":"521","type":"RC"},{"code":"99457","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":99,"gross_charge":116,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Salmonella, Total Ab By Eia Cvt","code_information":[{"code":"4302009","type":"CDM"},{"code":"302","type":"RC"},{"code":"86768","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":98,"gross_charge":115,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"11056 Paring/cutting Les 2-4","code_information":[{"code":"11056","type":"CDM"},{"code":"521","type":"RC"},{"code":"11056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":98,"gross_charge":115,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Metanephrines Fract, Ur Cvt","code_information":[{"code":"4302473","type":"CDM"},{"code":"301","type":"RC"},{"code":"83835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":97,"gross_charge":114,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Protein Electrophoresis, Ur Cvt","code_information":[{"code":"4302025","type":"CDM"},{"code":"301","type":"RC"},{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":97,"gross_charge":114,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Air-q Airway Size 1.5","code_information":[{"code":"4273070","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273070","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":97,"gross_charge":114,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Air-q Airway Size 2","code_information":[{"code":"4273075","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273075","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":97,"gross_charge":114,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Air-q Airway Size1","code_information":[{"code":"4273074","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273074","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":97,"gross_charge":114,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Air-q Sp3g Airway Size 3","code_information":[{"code":"4273905","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273905","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":97,"gross_charge":114,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Cath Coude 22fr","code_information":[{"code":"4273547","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273547","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":97,"gross_charge":114,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"96361hydration, Each Additional Hour- Hosp","code_information":[{"code":"4455081","type":"CDM"},{"code":"761","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"96366 Iv Infusion Therapy Prophylaxis/dx Ea Hour","code_information":[{"code":"4455083","type":"CDM"},{"code":"761","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"96375iv Injection, Each Additional New Drug- Hosp","code_information":[{"code":"4455088","type":"CDM"},{"code":"761","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Inj Ivp Ea Seque New Drug","code_information":[{"code":"4475088","type":"CDM"},{"code":"761","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Iv Hydrate Each Ad Hr","code_information":[{"code":"4475081","type":"CDM"},{"code":"761","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Iv Infus Therapy Ea Ad Hr","code_information":[{"code":"4475083","type":"CDM"},{"code":"761","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"95115 Allergy Injection Single Poc","code_information":[{"code":"95115","type":"CDM"},{"code":"949","type":"RC"},{"code":"95115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Allergy Injection Multi Poc","code_information":[{"code":"95117","type":"CDM"},{"code":"940","type":"RC"},{"code":"95117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Gliadin Antibodies Igg & A Cvt","code_information":[{"code":"4302138","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"J0515 Benztropine Mesylate Inj (2mg/2ml)","code_information":[{"code":"J0515","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":96,"gross_charge":113,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Needle Intraosseous(bone)","code_information":[{"code":"4273503","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273503","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":95,"gross_charge":112,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Epstein Barr Virus Capsid,igg Cvt","code_information":[{"code":"4302323","type":"CDM"},{"code":"302","type":"RC"},{"code":"86665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":95,"gross_charge":112,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Epstein Barr Virus Capsid,igm Cvt","code_information":[{"code":"4302322","type":"CDM"},{"code":"302","type":"RC"},{"code":"86665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":95,"gross_charge":112,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Homovanillic Acid, Ur 24hr Cvt","code_information":[{"code":"4302765","type":"CDM"},{"code":"301","type":"RC"},{"code":"83150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":95,"gross_charge":112,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"97763 Ot Orthotic Man/train Subs Encounter 15 Min","code_information":[{"code":"4409031","type":"CDM"},{"code":"431","type":"RC"},{"code":"97763","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":95,"gross_charge":112,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"97763 Orthotic Man/train Subs Ea 15 Min","code_information":[{"code":"4429031","type":"CDM"},{"code":"421","type":"RC"},{"code":"97763","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":95,"gross_charge":112,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"99439 Chronic Care Mgmt, Addl 20 Min","code_information":[{"code":"99439","type":"CDM"},{"code":"521","type":"RC"},{"code":"99439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":95,"gross_charge":112,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"T3, Free Cvt","code_information":[{"code":"4302739","type":"CDM"},{"code":"301","type":"RC"},{"code":"84481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":94,"gross_charge":110,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Pft Wo Bronchodilation","code_information":[{"code":"4413067","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":94,"gross_charge":110,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"99383 Preventive Medicine 5-11 Years New","code_information":[{"code":"99383-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99383","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":88,"maximum":94,"gross_charge":110,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Splint Lace-up Ankle X-lg","code_information":[{"code":"4273872","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273872","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":94,"gross_charge":110,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Splint Lace-up Ankle Univ","code_information":[{"code":"4273828","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273828","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":94,"gross_charge":110,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Afp","code_information":[{"code":"4302120","type":"CDM"},{"code":"301","type":"RC"},{"code":"82105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":93,"gross_charge":109,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Sirolimus Level Cvt","code_information":[{"code":"4302655","type":"CDM"},{"code":"301","type":"RC"},{"code":"80195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":93,"gross_charge":109,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Boot Ankle Walkr Lg","code_information":[{"code":"4273244","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273244","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":92,"gross_charge":108,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Boot Ankle Walkr Small","code_information":[{"code":"4273242","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273242","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":92,"gross_charge":108,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Lyme Disease Igg Ab,  Bld Cvt","code_information":[{"code":"4302457","type":"CDM"},{"code":"302","type":"RC"},{"code":"86618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":92,"gross_charge":108,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Metanephrines Fract, Ur 24hr Cvt","code_information":[{"code":"4302463","type":"CDM"},{"code":"301","type":"RC"},{"code":"83835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":92,"gross_charge":108,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"99403 Preventive Medicine Counseling, 45 Min","code_information":[{"code":"99403-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99403","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":86,"maximum":92,"gross_charge":108,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Counseling Risk Factor Intervention 45 Min","code_information":[{"code":"48099403","type":"CDM"},{"code":"521","type":"RC"},{"code":"99404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":92,"gross_charge":108,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"98927 Osteopathic Manipulative Treatment (Omt); 5-6 Body Regions Involved","code_information":[{"code":"98927","type":"CDM"},{"code":"521","type":"RC"},{"code":"98927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":92,"gross_charge":108,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Cortisol Free, Saliva 24hr Cvt","code_information":[{"code":"4302257","type":"CDM"},{"code":"301","type":"RC"},{"code":"82530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":91,"gross_charge":107,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Lamotrigine (Lamictal) Cvt","code_information":[{"code":"4302433","type":"CDM"},{"code":"301","type":"RC"},{"code":"80175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":91,"gross_charge":107,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Oxcarbazepine Metabolite Cvt","code_information":[{"code":"4302706","type":"CDM"},{"code":"301","type":"RC"},{"code":"80183","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":91,"gross_charge":107,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Blood test, thyroid stimulating hormone (TSH)","code_information":[{"code":"4300691","type":"CDM"},{"code":"301","type":"RC"},{"code":"84443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":91,"gross_charge":107,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Vitamin B1 Thiamine, Bld Cvt","code_information":[{"code":"4302695","type":"CDM"},{"code":"301","type":"RC"},{"code":"84425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":91,"gross_charge":107,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"29105 Pf Splint Long Arm Pro Ed Charge","code_information":[{"code":"CP17667781912897579","type":"CDM"},{"code":"CP17667781912897579","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":91,"gross_charge":107,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Catecholamines, Ur Cvt","code_information":[{"code":"4302060","type":"CDM"},{"code":"301","type":"RC"},{"code":"82382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":90,"gross_charge":106,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Cath Coude 14fr 5cc","code_information":[{"code":"4273543","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273543","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":90,"gross_charge":106,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Gentamicin,  Trough Cvt","code_information":[{"code":"4302355","type":"CDM"},{"code":"301","type":"RC"},{"code":"80170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":89,"gross_charge":105,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Gentamicin, Peak Cvt","code_information":[{"code":"4302014","type":"CDM"},{"code":"301","type":"RC"},{"code":"80170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":89,"gross_charge":105,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Hepatitis A,total Cvt","code_information":[{"code":"4302394","type":"CDM"},{"code":"302","type":"RC"},{"code":"86708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":89,"gross_charge":105,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Methylmalonic Acid, Ur By Gcms Cvt","code_information":[{"code":"4302581","type":"CDM"},{"code":"301","type":"RC"},{"code":"83921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":89,"gross_charge":105,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"B2 Microglobulin, Serum Cvt","code_information":[{"code":"4302114","type":"CDM"},{"code":"301","type":"RC"},{"code":"82232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Ethosuximide Cvt","code_information":[{"code":"4302728","type":"CDM"},{"code":"301","type":"RC"},{"code":"80168","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Homocysteine Cvt","code_information":[{"code":"4302410","type":"CDM"},{"code":"301","type":"RC"},{"code":"83090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Clct Bld Cnt/prph Ven Cth Charge","code_information":[{"code":"4453159","type":"CDM"},{"code":"761","type":"RC"},{"code":"36592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"17110 Destruct B9 Les Other Than Skin Tags Or Cut Vascular Prolif Lesions; Up To 14 Lesions Techni","code_information":[{"code":"17110","type":"CDM"},{"code":"521","type":"RC"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"29405 Short Leg Cast/below Knee To Toes Clinic Charge","code_information":[{"code":"29405","type":"CDM"},{"code":"521","type":"RC"},{"code":"29405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Foreign Body Remove, Corneal, W/o Slit Lamp Tech Chg","code_information":[{"code":"65220","type":"CDM"},{"code":"521","type":"RC"},{"code":"65220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Dermabond Skin Adhesive","code_information":[{"code":"4273335","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273335","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Xr Skull Complete","code_information":[{"code":"CP17667781913369958","type":"CDM"},{"code":"CP17667781913369958","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":88,"gross_charge":104,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Hepatitis B Core,  Total Cvt","code_information":[{"code":"4302399","type":"CDM"},{"code":"302","type":"RC"},{"code":"86704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Liver Kidney Microsome, Igg Cvt","code_information":[{"code":"4302688","type":"CDM"},{"code":"302","type":"RC"},{"code":"86376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Occult Blood","code_information":[{"code":"4300586","type":"CDM"},{"code":"301","type":"RC"},{"code":"82274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"99382 Preventive Medicine 1-4 Years New -","code_information":[{"code":"99382-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99382","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Sars-cov-2 (Covid-19) Rna (Id Now)","code_information":[{"code":"4302709","type":"CDM"},{"code":"306","type":"RC"},{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Sars-cov-2 Rna (Covid-19), Qualitative Naat Qst","code_information":[{"code":"43087635","type":"CDM"},{"code":"306","type":"RC"},{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"97113 Ot Aquati Therp Exerc/15 Min","code_information":[{"code":"4409016","type":"CDM"},{"code":"431","type":"RC"},{"code":"97113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Aquatic Charge","code_information":[{"code":"4403502","type":"CDM"},{"code":"431","type":"RC"},{"code":"97113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Aquatic Therapy Charge","code_information":[{"code":"4429012","type":"CDM"},{"code":"421","type":"RC"},{"code":"97113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Aquatic Therapy Charges","code_information":[{"code":"4423502","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":88,"gross_charge":103,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Procalcitonin","code_information":[{"code":"4302803","type":"CDM"},{"code":"301","type":"RC"},{"code":"84145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":87,"gross_charge":102,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Attendant Extra","code_information":[{"code":"4531008","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":87,"gross_charge":102,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Cortisol Am Cvt","code_information":[{"code":"4302059","type":"CDM"},{"code":"301","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":87,"gross_charge":102,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Cortisol Random Cvt","code_information":[{"code":"4302256","type":"CDM"},{"code":"301","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":87,"gross_charge":102,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Dexamethasone Cvt","code_information":[{"code":"4302241","type":"CDM"},{"code":"301","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":87,"gross_charge":102,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Folate (Folic Acid) Cvt","code_information":[{"code":"4302356","type":"CDM"},{"code":"301","type":"RC"},{"code":"82746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":87,"gross_charge":102,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Immunoglobulin E Cvt","code_information":[{"code":"4302472","type":"CDM"},{"code":"301","type":"RC"},{"code":"82785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":87,"gross_charge":102,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"99454 Telehealth Rem Monitor Physiol 16 Days Or More","code_information":[{"code":"99454","type":"CDM"},{"code":"521","type":"RC"},{"code":"99454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":87,"gross_charge":102,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Adl/self Care Tr 15m Charge","code_information":[{"code":"4429024","type":"CDM"},{"code":"421","type":"RC"},{"code":"97535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":86,"gross_charge":101,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Lacosamide Cvt","code_information":[{"code":"4302432","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":86,"gross_charge":101,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Arterial Line Insertion","code_information":[{"code":"CP17667781911043660","type":"CDM"},{"code":"CP17667781911043660","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Sars-cov-2 (Covid-19) State Spec Collection","code_information":[{"code":"43092023","type":"CDM"},{"code":"CP43092023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Saline Lock Vein Charge","code_information":[{"code":"4453224","type":"CDM"},{"code":"761","type":"RC"},{"code":"36000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"83992 Phencyclidine (Pcp) Poc","code_information":[{"code":"83992","type":"CDM"},{"code":"521","type":"RC"},{"code":"83992","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"69210 Rmvl Of Impacted Cerumen","code_information":[{"code":"44569210","type":"CDM"},{"code":"450","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Office/outpatient Visit Level 3 Established99213","code_information":[{"code":"99213-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99213","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Electrocardiogram, routine, with interpretation and report","code_information":[{"code":"93000","type":"CDM"},{"code":"730","type":"RC"},{"code":"93000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"11104 Punch Biopsy Skin Includes  Simple Closure Single Lesion","code_information":[{"code":"11104","type":"CDM"},{"code":"521","type":"RC"},{"code":"11104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"15783 Dermabrasion; Superficial, Face, Neck, Lrg Region","code_information":[{"code":"15783","type":"CDM"},{"code":"521","type":"RC"},{"code":"15783","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Qual Nonmd Est Pt < 21 Minutes","code_information":[{"code":"4389035","type":"CDM"},{"code":"441","type":"RC"},{"code":"98972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":85,"gross_charge":100,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Vancomycin Lvl Peak 1","code_information":[{"code":"4393155","type":"CDM"},{"code":"301","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Vancomycin Lvl Trough","code_information":[{"code":"4393154","type":"CDM"},{"code":"301","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Vancomycin, Peak Cvt","code_information":[{"code":"4302013","type":"CDM"},{"code":"301","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Vancomycin, Trough Cvt","code_information":[{"code":"4302729","type":"CDM"},{"code":"301","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Hepatitis C Ab Cvt","code_information":[{"code":"4302407","type":"CDM"},{"code":"302","type":"RC"},{"code":"86803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Thyr Peroxidase,thryoglob Ab Cvt","code_information":[{"code":"4302690","type":"CDM"},{"code":"302","type":"RC"},{"code":"86800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Vma, Ur 24hr Cvt","code_information":[{"code":"4302730","type":"CDM"},{"code":"301","type":"RC"},{"code":"84585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"20612 Aspirtn And/or Inj Of Ganglion Cyst(s) Any Location Charge","code_information":[{"code":"20612","type":"CDM"},{"code":"521","type":"RC"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Arthrocentesis, Aspiration And Or Injection; Major Joint Or Bursa  Technical Charge","code_information":[{"code":"20610","type":"CDM"},{"code":"521","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Inj(s); Single Or Mult Trigger Point(s), One Or Two Muscle(s) Tech Chg","code_information":[{"code":"20552","type":"CDM"},{"code":"521","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"97542 Wheelchair Mgmt Ea 15 Min","code_information":[{"code":"4400019","type":"CDM"},{"code":"431","type":"RC"},{"code":"97542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"97542 Wheelchair Management Ea 15 Min","code_information":[{"code":"4429032","type":"CDM"},{"code":"421","type":"RC"},{"code":"97542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":84,"gross_charge":99,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Norovirus Ag Cvt","code_information":[{"code":"4302638","type":"CDM"},{"code":"306","type":"RC"},{"code":"87449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":83,"gross_charge":98,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"T3, Total Cvt","code_information":[{"code":"4302746","type":"CDM"},{"code":"301","type":"RC"},{"code":"84480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":83,"gross_charge":98,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Theophylline Level Cvt","code_information":[{"code":"4302685","type":"CDM"},{"code":"301","type":"RC"},{"code":"80198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":83,"gross_charge":98,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Ambu Bag Pedi Resusitator","code_information":[{"code":"4273563","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273563","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":82,"gross_charge":97,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Sodium, 24 Hr Urine","code_information":[{"code":"4302724","type":"CDM"},{"code":"301","type":"RC"},{"code":"84300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":82,"gross_charge":97,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Heel/foot Positionr Elevator","code_information":[{"code":"4273158","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273158","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":82,"gross_charge":97,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"96368 Iv Infusion, Concurrent- Hosp","code_information":[{"code":"4455085","type":"CDM"},{"code":"761","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"96376iv Injection, Add Same Drug 31 Min Later- Hosp","code_information":[{"code":"4455089","type":"CDM"},{"code":"761","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Vit B12 Level Cvt","code_information":[{"code":"4302665","type":"CDM"},{"code":"301","type":"RC"},{"code":"82607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Inj Ivp Ea Seq Same Drug","code_information":[{"code":"4475089","type":"CDM"},{"code":"761","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Iv Infus Ther Concurrent","code_information":[{"code":"4475085","type":"CDM"},{"code":"761","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"29125 Ot Splint Short Arm Static","code_information":[{"code":"4409001","type":"CDM"},{"code":"431","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"29125 Splint Short Arm Static","code_information":[{"code":"4404006","type":"CDM"},{"code":"431","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"4409014","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"4400007","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"4423049","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"4429010","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Blood Typing; Rh","code_information":[{"code":"4300197","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":82,"gross_charge":96,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Splint Ankle Floam Lft/rt","code_information":[{"code":"4273430","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273430","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":81,"gross_charge":95,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Ammonia Level","code_information":[{"code":"4300123","type":"CDM"},{"code":"301","type":"RC"},{"code":"82140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":81,"gross_charge":95,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Carbamazepine Level","code_information":[{"code":"4300683","type":"CDM"},{"code":"301","type":"RC"},{"code":"80156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":81,"gross_charge":95,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Epstein Barr Virus Nuclear,igg Cvt","code_information":[{"code":"4302325","type":"CDM"},{"code":"302","type":"RC"},{"code":"86664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":81,"gross_charge":95,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"99381 Preventive Medicine < 1 Year New","code_information":[{"code":"99381-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99381","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":76,"maximum":81,"gross_charge":95,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"J0500 Dicyclomine Hci, Injection Up To 20mg","code_information":[{"code":"J0500","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":81,"gross_charge":95,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Ambu Bag Infant Resusitator","code_information":[{"code":"4273562","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273562","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":80,"gross_charge":94,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Imitrex, Sumatriptan Succinate, Per 6 Mg","code_information":[{"code":"J3030","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":80,"gross_charge":94,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Thyroid Peroxidase Antibody Cvt","code_information":[{"code":"4302691","type":"CDM"},{"code":"302","type":"RC"},{"code":"86376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":79,"gross_charge":93,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Psychotherapy, 30 Minutes With Patient When Performed As An Evaluation And Mamnagement Service","code_information":[{"code":"90833-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90833","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":74,"maximum":79,"gross_charge":93,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Dressing Vac Sensa Trac Pad (Only)","code_information":[{"code":"4273183","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273183","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":79,"gross_charge":93,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"M0201 In-home Vaccine Administration","code_information":[{"code":"M0201","type":"CDM"},{"code":"521","type":"RC"},{"code":"M0201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":78,"gross_charge":92,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Rubella, Igg Cvt","code_information":[{"code":"4302634","type":"CDM"},{"code":"302","type":"RC"},{"code":"86762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":78,"gross_charge":92,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Uric Acid","code_information":[{"code":"4302781","type":"CDM"},{"code":"301","type":"RC"},{"code":"84560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":78,"gross_charge":92,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"97760 Initial Orthotic Train/15min Charge","code_information":[{"code":"4409029","type":"CDM"},{"code":"431","type":"RC"},{"code":"97760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":78,"gross_charge":92,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Orthotic Mgmt And Training Charges","code_information":[{"code":"4403469","type":"CDM"},{"code":"431","type":"RC"},{"code":"97760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":78,"gross_charge":92,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Orthotic Fitting/training Charge","code_information":[{"code":"4429029","type":"CDM"},{"code":"421","type":"RC"},{"code":"97760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":78,"gross_charge":92,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Orthotic Mgmt And Training Charges","code_information":[{"code":"4423469","type":"CDM"},{"code":"421","type":"RC"},{"code":"97760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":78,"gross_charge":92,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}]},{"description":"Rotavirus Ag Cvt","code_information":[{"code":"4302028","type":"CDM"},{"code":"306","type":"RC"},{"code":"87425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":77,"gross_charge":91,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"10040 Acne Surgery (Eg. Marsupialization, Opening Or Removal Of Multiple Milia, Comedones, Cysts, Pu","code_information":[{"code":"10040","type":"CDM"},{"code":"521","type":"RC"},{"code":"10040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":77,"gross_charge":91,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"11732 Avulsion Of Nail Plate, Partial Or Complete, Simple; Each Addtl Nail Platecharge","code_information":[{"code":"11732","type":"CDM"},{"code":"521","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":77,"gross_charge":91,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Foreign Body Remove, Superficial Conjunctival Tech Chg","code_information":[{"code":"65205","type":"CDM"},{"code":"521","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":77,"gross_charge":91,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Cpm Fleece Pad","code_information":[{"code":"4273924","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273924","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":77,"gross_charge":91,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Blood test, lipids","code_information":[{"code":"4302445","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Blood test, lipids","code_information":[{"code":"4300445","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Blood test, lipids","code_information":[{"code":"4300442","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Tacrolimus, (Prograf) Cvt","code_information":[{"code":"4302657","type":"CDM"},{"code":"301","type":"RC"},{"code":"80197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Cpt Initial  Rt Charge","code_information":[{"code":"4413027","type":"CDM"},{"code":"412","type":"RC"},{"code":"94667","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"99393 Preventive Medicine 5-11 Years Established","code_information":[{"code":"99393-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99393","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"98926 Osteopathic Manipulative Treatment (Omt); 3-4 Body Regions Involved","code_information":[{"code":"98926","type":"CDM"},{"code":"521","type":"RC"},{"code":"98926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Wound Care Non-selective Debridement, Caddo","code_information":[{"code":"97602","type":"CDM"},{"code":"521","type":"RC"},{"code":"97602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Purewick Male External Catheter","code_information":[{"code":"4273117","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273117","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":77,"gross_charge":90,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Knee/immob/sm-16","code_information":[{"code":"4273590","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"Ferritin Cvt","code_information":[{"code":"4302343","type":"CDM"},{"code":"301","type":"RC"},{"code":"82728","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"29130 Ot Splint Finger Static","code_information":[{"code":"4409003","type":"CDM"},{"code":"431","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"29130 Splint Finger Static","code_information":[{"code":"4404008","type":"CDM"},{"code":"431","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"29125 Pf Splint Application Pro Ed Charge","code_information":[{"code":"CP17667781912897069","type":"CDM"},{"code":"CP17667781912897069","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"29130 Applic Of Finger Splint; Static Ed Pro Fee","code_information":[{"code":"CP17667781912896389","type":"CDM"},{"code":"CP17667781912896389","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"97530 Ot Therapeutic Activity Charge","code_information":[{"code":"4409024","type":"CDM"},{"code":"431","type":"RC"},{"code":"97530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"97530 Therapeut Proc/ot Charge","code_information":[{"code":"CP17667781911643895","type":"CDM"},{"code":"431","type":"RC"},{"code":"97530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"Therapeutic Activities Charges","code_information":[{"code":"4400009","type":"CDM"},{"code":"431","type":"RC"},{"code":"97530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"97530 Therapeutic Activity (Ea. 15 Mins) Charge","code_information":[{"code":"4429023","type":"CDM"},{"code":"421","type":"RC"},{"code":"97530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"Functional Training Charges","code_information":[{"code":"4423011","type":"CDM"},{"code":"421","type":"RC"},{"code":"97530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"Hepatitis A Vaccine, Pediatric/adolescent Dosage-3 Dose Schedule, For Im Use Poc","code_information":[{"code":"90634","type":"CDM"},{"code":"636","type":"RC"},{"code":"90634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":76,"gross_charge":89,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Valproic Acid, (Depakene) Cvt","code_information":[{"code":"4302727","type":"CDM"},{"code":"301","type":"RC"},{"code":"80164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":75,"gross_charge":88,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"97755 Ot Tech Asses W/ Rprt Ea 15","code_information":[{"code":"4409028","type":"CDM"},{"code":"431","type":"RC"},{"code":"97755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":75,"gross_charge":88,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"97755 Tech Asses W/ Rprt Ea 15","code_information":[{"code":"4400018","type":"CDM"},{"code":"431","type":"RC"},{"code":"97755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":75,"gross_charge":88,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Group A Strep By Pcr Poc","code_information":[{"code":"87651","type":"CDM"},{"code":"306","type":"RC"},{"code":"87651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":75,"gross_charge":88,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Potassium Urine 24 Hr","code_information":[{"code":"4302775","type":"CDM"},{"code":"301","type":"RC"},{"code":"84133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":75,"gross_charge":88,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Chest Tube Cath 10fr","code_information":[{"code":"4273421","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273421","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":75,"gross_charge":88,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Chest Tube Cath 20fr","code_information":[{"code":"4273423","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273423","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":75,"gross_charge":88,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Alpha-1 Antitrypsin Cvt","code_information":[{"code":"4302118","type":"CDM"},{"code":"301","type":"RC"},{"code":"82103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Quad Screen Cvt","code_information":[{"code":"4302152","type":"CDM"},{"code":"301","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Ribosomal P Antibody Cvt","code_information":[{"code":"4302052","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"97140 Manual Therapy/15min Charge","code_information":[{"code":"4409018","type":"CDM"},{"code":"431","type":"RC"},{"code":"97140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Manual Therapy Charge Units","code_information":[{"code":"4403065","type":"CDM"},{"code":"431","type":"RC"},{"code":"97140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"97140 Manual Therapy Charge","code_information":[{"code":"4429016","type":"CDM"},{"code":"421","type":"RC"},{"code":"97140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Manual Therapy Charge Units","code_information":[{"code":"4423474","type":"CDM"},{"code":"421","type":"RC"},{"code":"97140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Pt Manual Therapy Charge","code_information":[{"code":"4429017","type":"CDM"},{"code":"421","type":"RC"},{"code":"97140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Oxygen Hut 24x24 Mist Tnt","code_information":[{"code":"4273999","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":74,"gross_charge":87,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Phenytoin Lvl","code_information":[{"code":"4300311","type":"CDM"},{"code":"301","type":"RC"},{"code":"80185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":73,"gross_charge":86,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}]},{"description":"11001 Debrid Ea Add 10% Bod Sur","code_information":[{"code":"4453017","type":"CDM"},{"code":"761","type":"RC"},{"code":"11001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":73,"gross_charge":86,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}]},{"description":"Removal Of Iud [Cchd]","code_information":[{"code":"4453301","type":"CDM"},{"code":"450","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":72,"gross_charge":85,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Digoxin Level","code_information":[{"code":"4300309","type":"CDM"},{"code":"301","type":"RC"},{"code":"80162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":72,"gross_charge":85,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"29520 Strapping Hip.","code_information":[{"code":"4453142","type":"CDM"},{"code":"761","type":"RC"},{"code":"29520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":72,"gross_charge":85,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Dot Physical","code_information":[{"code":"99499D","type":"CDM"},{"code":"521","type":"RC"},{"code":"99499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":72,"gross_charge":85,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Office Visit No Charge","code_information":[{"code":"99499M","type":"CDM"},{"code":"521","type":"RC"},{"code":"99499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":72,"gross_charge":85,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Fluzone Pfs Tiv Influenza Vaccine","code_information":[{"code":"90662","type":"CDM"},{"code":"636","type":"RC"},{"code":"90662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":72,"gross_charge":85,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Removal Of Intrauterine Devise (Iud)","code_information":[{"code":"44558301","type":"CDM"},{"code":"761","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":72,"gross_charge":85,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"C-reactive Protein Cardio","code_information":[{"code":"4300200","type":"CDM"},{"code":"302","type":"RC"},{"code":"86141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"D-dimer, High Sensitivity Cvt","code_information":[{"code":"4302035","type":"CDM"},{"code":"305","type":"RC"},{"code":"85380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Herpes Simplex 1/2, Igg Cvt","code_information":[{"code":"4302400","type":"CDM"},{"code":"302","type":"RC"},{"code":"86695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Herpes Simplex 1/2, Igm Cvt","code_information":[{"code":"4302056","type":"CDM"},{"code":"302","type":"RC"},{"code":"86695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Kappa Lambda Lite Chains,ur Cvt","code_information":[{"code":"4302474","type":"CDM"},{"code":"301","type":"RC"},{"code":"83883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Sickle Cell Prep Cvt","code_information":[{"code":"4302667","type":"CDM"},{"code":"305","type":"RC"},{"code":"85660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"97533 Ot Sensory Integrative Technique Charge","code_information":[{"code":"4409026","type":"CDM"},{"code":"431","type":"RC"},{"code":"97533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Sensory Stimulation Charge","code_information":[{"code":"4403570","type":"CDM"},{"code":"431","type":"RC"},{"code":"97533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Sensory Integration Charges","code_information":[{"code":"4380008","type":"CDM"},{"code":"444","type":"RC"},{"code":"97533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"99392 Preventive Medicine 1-4 Years Established","code_information":[{"code":"99392-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99392","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"97535 Ot Self Care Mgmt Traning Charge","code_information":[{"code":"4409027","type":"CDM"},{"code":"431","type":"RC"},{"code":"97535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"97535 Self Care/home Mngmt Charge","code_information":[{"code":"CP17667781911646457","type":"CDM"},{"code":"431","type":"RC"},{"code":"97535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Adl Training Charges","code_information":[{"code":"4400010","type":"CDM"},{"code":"431","type":"RC"},{"code":"97535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":71,"gross_charge":84,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Giardia & Cryptosporidium Ag Cvt","code_information":[{"code":"4302265","type":"CDM"},{"code":"306","type":"RC"},{"code":"87328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":71,"gross_charge":83,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Lipoprotein (A) Cvt","code_information":[{"code":"4302083","type":"CDM"},{"code":"301","type":"RC"},{"code":"83695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":71,"gross_charge":83,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Mitochondrial Ab, Igg Cvt","code_information":[{"code":"4302464","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":71,"gross_charge":83,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Mumps Virus, Igg Cvt","code_information":[{"code":"4302571","type":"CDM"},{"code":"302","type":"RC"},{"code":"86735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":71,"gross_charge":83,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Myoglobin, Ur Cvt","code_information":[{"code":"4302573","type":"CDM"},{"code":"301","type":"RC"},{"code":"83874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":71,"gross_charge":83,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Cath Foley 6 Fr 1.5cc","code_information":[{"code":"4273256","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273256","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":70,"gross_charge":82,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Apolipoprotein B Cvt","code_information":[{"code":"4302080","type":"CDM"},{"code":"301","type":"RC"},{"code":"82172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":70,"gross_charge":82,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"99307 Subsequent Swingbed Level1","code_information":[{"code":"99307-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99307","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":66,"maximum":70,"gross_charge":82,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"11045 Debridement, Subcutaneous Tissue; Each Additional 20 Sq Cm","code_information":[{"code":"11045","type":"CDM"},{"code":"521","type":"RC"},{"code":"11045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":70,"gross_charge":82,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"20605 Arthrocentesis, Aspiration And Or Injection; Intermediate Joint Or Bursa  Technical Charge","code_information":[{"code":"20605","type":"CDM"},{"code":"521","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":70,"gross_charge":82,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Paring Or Cutting Of Benign Hyperkeratotic Lesion (Eg, Corn Or Callus); Single Lesion","code_information":[{"code":"11055","type":"CDM"},{"code":"521","type":"RC"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":70,"gross_charge":82,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Brace Ankle Stirrup","code_information":[{"code":"L4350","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":70,"gross_charge":82,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Crutches X-long","code_information":[{"code":"4273561","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273561","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":70,"gross_charge":82,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Influenza B Antigen","code_information":[{"code":"4300474","type":"CDM"},{"code":"306","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Influenza A&b Rapid","code_information":[{"code":"4300473","type":"CDM"},{"code":"306","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Respiratory Syncytial Virus","code_information":[{"code":"4300475","type":"CDM"},{"code":"306","type":"RC"},{"code":"87807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Strep A Eia Screen Standard","code_information":[{"code":"4300673","type":"CDM"},{"code":"306","type":"RC"},{"code":"87880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Strep B Latex","code_information":[{"code":"4300675","type":"CDM"},{"code":"306","type":"RC"},{"code":"87449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"20979 Ot Us Low Inten Healing","code_information":[{"code":"4409000","type":"CDM"},{"code":"431","type":"RC"},{"code":"20979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"20979 Us Low Inten Healing","code_information":[{"code":"4400017","type":"CDM"},{"code":"431","type":"RC"},{"code":"20979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Rapid Flu A/b Poc","code_information":[{"code":"87804","type":"CDM"},{"code":"306","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Comprehensive Assessamentadd On Code For Initiating Visit","code_information":[{"code":"G0506","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Neuro Reeduc/15 Min Charge, Pta","code_information":[{"code":"4409015","type":"CDM"},{"code":"431","type":"RC"},{"code":"97112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Neuromuscular Reeducation Charges","code_information":[{"code":"4403037","type":"CDM"},{"code":"431","type":"RC"},{"code":"97112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Neuro Re-education (Ea. 15 Mins) Charge, Pta","code_information":[{"code":"4429011","type":"CDM"},{"code":"421","type":"RC"},{"code":"97112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Neuromuscular Reeducation Charges","code_information":[{"code":"4423037","type":"CDM"},{"code":"421","type":"RC"},{"code":"97112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":69,"gross_charge":81,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"97761 Ot Pros Train Up/low Ex 15m","code_information":[{"code":"4409030","type":"CDM"},{"code":"431","type":"RC"},{"code":"97761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":68,"gross_charge":80,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Prosthetic Charge","code_information":[{"code":"4403046","type":"CDM"},{"code":"431","type":"RC"},{"code":"97761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":68,"gross_charge":80,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Prosthetic Training (Ea. 15 Mins) Charge","code_information":[{"code":"4429030","type":"CDM"},{"code":"421","type":"RC"},{"code":"97761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":68,"gross_charge":80,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Prosthetic Training Charges","code_information":[{"code":"4423555","type":"CDM"},{"code":"421","type":"RC"},{"code":"97761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":68,"gross_charge":80,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Insulin Cvt","code_information":[{"code":"4302420","type":"CDM"},{"code":"301","type":"RC"},{"code":"83525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":67,"gross_charge":79,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"90648 Hemophilus Influenza B Vaccine (Hib), Prp-t Conjugate (4 Dose Schedule), For Intramuscular Use","code_information":[{"code":"90648","type":"CDM"},{"code":"636","type":"RC"},{"code":"90648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":67,"gross_charge":79,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Anti-centromere Antibody Cvt","code_information":[{"code":"4302053","type":"CDM"},{"code":"302","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Hepatitis A,  Igm Cvt","code_information":[{"code":"4302395","type":"CDM"},{"code":"302","type":"RC"},{"code":"86709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Crutches/adult Tall 5'10 To 6'6","code_information":[{"code":"4273560","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273560","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"99391 Preventive Medicine < 1 Year Established","code_information":[{"code":"99391-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99391","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"11901 Inject Skin Lesions ]7clinic","code_information":[{"code":"11901","type":"CDM"},{"code":"521","type":"RC"},{"code":"11901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Application Of Short Leg Splint (Calf To Footprof","code_information":[{"code":"29515","type":"CDM"},{"code":"521","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Cast Short Arm","code_information":[{"code":"29075","type":"CDM"},{"code":"521","type":"RC"},{"code":"29075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Dressings And/or Debridement Of Partial-thickness Burns, Initial Or Subsequent; Small Tech Chg","code_information":[{"code":"16020","type":"CDM"},{"code":"521","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Evacuation Of Subungual Hematoma Technical Charge","code_information":[{"code":"11740","type":"CDM"},{"code":"521","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Injection(s); Single Tendon Origin/insertion","code_information":[{"code":"20551","type":"CDM"},{"code":"521","type":"RC"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel","code_information":[{"code":"20526","type":"CDM"},{"code":"521","type":"RC"},{"code":"20526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":66,"gross_charge":78,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Knee Immob/lg-24","code_information":[{"code":"4273592","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Complement  C4 Cvt","code_information":[{"code":"4302243","type":"CDM"},{"code":"302","type":"RC"},{"code":"86160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Complement C3 Cvt","code_information":[{"code":"4302242","type":"CDM"},{"code":"302","type":"RC"},{"code":"86160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Lead, Bld Cvt","code_information":[{"code":"4302440","type":"CDM"},{"code":"301","type":"RC"},{"code":"83655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"97116 Gait/crutch Training Charge","code_information":[{"code":"4429013","type":"CDM"},{"code":"421","type":"RC"},{"code":"97116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Aquatic Therapy Charges","code_information":[{"code":"4423013","type":"CDM"},{"code":"421","type":"RC"},{"code":"97116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Gait Training Charge","code_information":[{"code":"CP17667781912188460","type":"CDM"},{"code":"421","type":"RC"},{"code":"97116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"97033 Iontophoresis/15 Min Charge","code_information":[{"code":"4409011","type":"CDM"},{"code":"431","type":"RC"},{"code":"97033","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Iontophoresis Charges","code_information":[{"code":"4403070","type":"CDM"},{"code":"431","type":"RC"},{"code":"97033","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Ionopheresis/15 Min Charge","code_information":[{"code":"4429006","type":"CDM"},{"code":"421","type":"RC"},{"code":"97033","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Iontophoresis Charges","code_information":[{"code":"4423067","type":"CDM"},{"code":"421","type":"RC"},{"code":"97033","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":65,"gross_charge":77,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Crutches/adult Reg","code_information":[{"code":"4273559","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273559","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":65,"gross_charge":76,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Tobramycin, Peak Cvt","code_information":[{"code":"4302922","type":"CDM"},{"code":"301","type":"RC"},{"code":"80200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":65,"gross_charge":76,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Tobramycin, Trough Cvt","code_information":[{"code":"4302920","type":"CDM"},{"code":"301","type":"RC"},{"code":"80200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":65,"gross_charge":76,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"99409 Alcohol Substance Screen > 30 Minutes","code_information":[{"code":"99409-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99409","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":61,"maximum":65,"gross_charge":76,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Hand Mitts Dbl Security","code_information":[{"code":"4273971","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273971","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Anti-nuclear Ab Screen Cvt","code_information":[{"code":"4302133","type":"CDM"},{"code":"302","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Surg Path Level Iii Bill Only","code_information":[{"code":"4306438","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Varicella-zoster Ab, Igm  Eia Cvt","code_information":[{"code":"4302732","type":"CDM"},{"code":"302","type":"RC"},{"code":"86787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Cchd Stat Chg Doppler Per Test","code_information":[{"code":"4430420","type":"CDM"},{"code":"921","type":"RC"},{"code":"CP4430420","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Cath Coude 18fr 30cc  Ltx","code_information":[{"code":"4273565","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273565","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"99212 Office/op Established  Visit Level 2","code_information":[{"code":"99212-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99212","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Acp Discussion Additional 30 Mins","code_information":[{"code":"99498-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99498","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"93005 Electrocardiogram, Routine Ecg With At Least 12 Leads; Tracing Only, W/o Interp And Report","code_information":[{"code":"CP17667782174873317","type":"CDM"},{"code":"CP17667782174873317","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Subseq Obs Care Level I Charge","code_information":[{"code":"4447111-AQ","type":"CDM"},{"code":"99224","type":"CPT","modifier":"AQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AQ"],"minimum":60,"maximum":64,"gross_charge":75,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Actin (Smooth Muscle) Ab Igg Cvt","code_information":[{"code":"4302137","type":"CDM"},{"code":"301","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":63,"gross_charge":74,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Hepatitis B Surface Ab, Quant Cvt","code_information":[{"code":"4302403","type":"CDM"},{"code":"302","type":"RC"},{"code":"86706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":63,"gross_charge":74,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Phenobarbital Cvt","code_information":[{"code":"4302593","type":"CDM"},{"code":"301","type":"RC"},{"code":"80184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":63,"gross_charge":74,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Vitamin A (Retinol) Cvt","code_information":[{"code":"4302000","type":"CDM"},{"code":"301","type":"RC"},{"code":"84590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":63,"gross_charge":74,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Vitamin D Total","code_information":[{"code":"4300205","type":"CDM"},{"code":"301","type":"RC"},{"code":"82306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":63,"gross_charge":74,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"11719 Trim Nondystrophic Nails","code_information":[{"code":"4453225","type":"CDM"},{"code":"761","type":"RC"},{"code":"11719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":63,"gross_charge":74,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"29550 Strapping Toes.","code_information":[{"code":"4453145","type":"CDM"},{"code":"761","type":"RC"},{"code":"29550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":63,"gross_charge":74,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Vest Restraint Med.","code_information":[{"code":"4273123","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273123","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":63,"gross_charge":74,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Afb Smear","code_information":[{"code":"4302111","type":"CDM"},{"code":"306","type":"RC"},{"code":"87206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":62,"gross_charge":73,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Culture, Afb W  Smear Cvt","code_information":[{"code":"4302109","type":"CDM"},{"code":"306","type":"RC"},{"code":"87116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":62,"gross_charge":73,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Ot Group Therapy Charge","code_information":[{"code":"4409019","type":"CDM"},{"code":"433","type":"RC"},{"code":"97150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":62,"gross_charge":73,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Yesgroup Therapy Provided","code_information":[{"code":"4400008","type":"CDM"},{"code":"433","type":"RC"},{"code":"97150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":62,"gross_charge":73,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"97150 Ther Procedures Group","code_information":[{"code":"4429018","type":"CDM"},{"code":"421","type":"RC"},{"code":"97150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":62,"gross_charge":73,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Yesgroup Therapy Charge","code_information":[{"code":"4423477","type":"CDM"},{"code":"421","type":"RC"},{"code":"97150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":62,"gross_charge":73,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Crutches/youth","code_information":[{"code":"4273558","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273558","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":62,"gross_charge":73,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Sling Arm Pedi / Child","code_information":[{"code":"4273156","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273156","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":62,"gross_charge":73,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Ceruloplasmin Cvt","code_information":[{"code":"4302216","type":"CDM"},{"code":"301","type":"RC"},{"code":"82390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":61,"gross_charge":72,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"99402 Preventive Medicine Counseling, 30 Min","code_information":[{"code":"99402-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99402","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":58,"maximum":61,"gross_charge":72,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Counseling Risk Factor Intervention 30 Min","code_information":[{"code":"48099402","type":"CDM"},{"code":"521","type":"RC"},{"code":"99402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":61,"gross_charge":72,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Splint Masonallen Med","code_information":[{"code":"4273659","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273659","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":60,"gross_charge":71,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Intrinsic Factor Ab Cvt","code_information":[{"code":"4302918","type":"CDM"},{"code":"302","type":"RC"},{"code":"86340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":60,"gross_charge":71,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Zinc, Serum-plasma Cvt","code_information":[{"code":"4302743","type":"CDM"},{"code":"301","type":"RC"},{"code":"84630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":60,"gross_charge":71,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Ppd Adminstration Poc","code_information":[{"code":"86580","type":"CDM"},{"code":"302","type":"RC"},{"code":"86580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":60,"gross_charge":71,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Acinetobacter Baumannii","code_information":[{"code":"43008715","type":"CDM"},{"code":"306","type":"RC"},{"code":"87150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":60,"gross_charge":70,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Candida Albicans","code_information":[{"code":"43087150","type":"CDM"},{"code":"306","type":"RC"},{"code":"87150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":60,"gross_charge":70,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Pinworm Exam Cvt","code_information":[{"code":"4302603","type":"CDM"},{"code":"306","type":"RC"},{"code":"87172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":60,"gross_charge":70,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"90633 Hepatitis A Vaccine, Pediatric/adolescent Dosage-2 Dose Schedule, For Intramuscular Use","code_information":[{"code":"90633","type":"CDM"},{"code":"636","type":"RC"},{"code":"90633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":60,"gross_charge":70,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Dressing Vac White Foam Lg (Foam Only)","code_information":[{"code":"4273859","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273859","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":60,"gross_charge":70,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Ethanol Level","code_information":[{"code":"4300117","type":"CDM"},{"code":"301","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":59,"gross_charge":69,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"90714 Tetanus-diphtheria (Td) Pf 7yrs Up","code_information":[{"code":"90714","type":"CDM"},{"code":"636","type":"RC"},{"code":"90714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":59,"gross_charge":69,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Haptoglobin Cvt","code_information":[{"code":"4302384","type":"CDM"},{"code":"301","type":"RC"},{"code":"83010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":58,"gross_charge":68,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Lactic Acid","code_information":[{"code":"4300451","type":"CDM"},{"code":"301","type":"RC"},{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":58,"gross_charge":68,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Lactic Acid Cvt","code_information":[{"code":"4302451","type":"CDM"},{"code":"301","type":"RC"},{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":58,"gross_charge":68,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Protein Electrophoresis, Ser Cvt","code_information":[{"code":"4302326","type":"CDM"},{"code":"301","type":"RC"},{"code":"84165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":58,"gross_charge":68,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Shbg Cvt","code_information":[{"code":"4302654","type":"CDM"},{"code":"301","type":"RC"},{"code":"84270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":58,"gross_charge":68,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"98925 Osteopathic Manipulative Treatment (Omt); One To Two Body Regions Involved","code_information":[{"code":"98925","type":"CDM"},{"code":"521","type":"RC"},{"code":"98925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":58,"gross_charge":68,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Splint Mason Allen Lg","code_information":[{"code":"4273660","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273660","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":57,"gross_charge":67,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Diptheria,tetanus Toxoidacellular Pretusses Imvaccine Dtap Charge","code_information":[{"code":"90700","type":"CDM"},{"code":"636","type":"RC"},{"code":"90700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":56,"gross_charge":66,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Blood Culture Cvt","code_information":[{"code":"4302290","type":"CDM"},{"code":"306","type":"RC"},{"code":"87040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":56,"gross_charge":66,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Hepatitis B Surface  Ag Cvt","code_information":[{"code":"4302401","type":"CDM"},{"code":"306","type":"RC"},{"code":"87340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":56,"gross_charge":66,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Blood Culture","code_information":[{"code":"4300281","type":"CDM"},{"code":"306","type":"RC"},{"code":"87040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":56,"gross_charge":66,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"11201 Skin Tag Rmv Ea Add'l","code_information":[{"code":"11201","type":"CDM"},{"code":"521","type":"RC"},{"code":"11201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":56,"gross_charge":66,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"20600 Arthrocentesis, Aspirtn And/or Inj; Small Joint Or Bursa (Eg, Fingers, Toes) Charge","code_information":[{"code":"20600","type":"CDM"},{"code":"521","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":56,"gross_charge":66,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Oxygen Longterm Nebulizer /W Reservoir","code_information":[{"code":"4273903","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273903","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":56,"gross_charge":66,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Hemoglobin A1c Standard","code_information":[{"code":"4300375","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Protein C Activity Cvt","code_information":[{"code":"4302185","type":"CDM"},{"code":"305","type":"RC"},{"code":"85303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Protein S Activity Cvt","code_information":[{"code":"4302184","type":"CDM"},{"code":"305","type":"RC"},{"code":"85306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"97016 Ot Vasopneumatic Device Chargevasopneumatic Device Charge","code_information":[{"code":"4400003","type":"CDM"},{"code":"431","type":"RC"},{"code":"97016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"97016 Vasopneumatic Device","code_information":[{"code":"4409007","type":"CDM"},{"code":"431","type":"RC"},{"code":"97016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"97022 Fluidotherapy","code_information":[{"code":"4409009","type":"CDM"},{"code":"431","type":"RC"},{"code":"97022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"97032 Ot Elec/stim Attended 15 Min","code_information":[{"code":"4409010","type":"CDM"},{"code":"431","type":"RC"},{"code":"97032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Attended E-stim Charges","code_information":[{"code":"4403009","type":"CDM"},{"code":"431","type":"RC"},{"code":"97032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Whirlpoolwhirlpool Extremity Charge","code_information":[{"code":"4403058","type":"CDM"},{"code":"431","type":"RC"},{"code":"97022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"97016 Pt Vasopneumatic Device Chargevasopneumatic Device Charge","code_information":[{"code":"4423063","type":"CDM"},{"code":"421","type":"RC"},{"code":"97016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"97022 Aseptic Whirlpool Sm Charge","code_information":[{"code":"CP17667781912180712","type":"CDM"},{"code":"421","type":"RC"},{"code":"97022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"97022 Whirlpool Charge","code_information":[{"code":"4429004","type":"CDM"},{"code":"421","type":"RC"},{"code":"97022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"97129 Therapeutic Interventions That Focus On Cognitive Function; Initial 15 Minutes (Pt)","code_information":[{"code":"CP17667781912183280","type":"CDM"},{"code":"CP17667781912183280","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Attended E-stim Charges","code_information":[{"code":"4423008","type":"CDM"},{"code":"421","type":"RC"},{"code":"97032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Mechanical Tractionmechanical Traction Charge","code_information":[{"code":"4423068","type":"CDM"},{"code":"421","type":"RC"},{"code":"97012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Pt Cognitive Function Charge","code_information":[{"code":"44297129","type":"CDM"},{"code":"421","type":"RC"},{"code":"97129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Pt Whirlpool Full Bodywhirlpool Full Body Charge","code_information":[{"code":"4423057","type":"CDM"},{"code":"421","type":"RC"},{"code":"97022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Traction Mechanical Charge","code_information":[{"code":"4429001","type":"CDM"},{"code":"421","type":"RC"},{"code":"97012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Ultrasound W/elec. S Charge","code_information":[{"code":"4429005","type":"CDM"},{"code":"421","type":"RC"},{"code":"97032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Vaso/pneumatic Treatment Charge","code_information":[{"code":"4429003","type":"CDM"},{"code":"421","type":"RC"},{"code":"97016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Slp Cog Ther Intervent,first 15min Units","code_information":[{"code":"43897129","type":"CDM"},{"code":"441","type":"RC"},{"code":"97129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Splint Lmb Finger Spring Extension","code_information":[{"code":"4273372","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273372","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"16000 Initial Trtmt, First Degree Burn, When No More Than Local Trtmt Is Required Charge","code_information":[{"code":"16000","type":"CDM"},{"code":"521","type":"RC"},{"code":"16000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"29125 Application Of Short Arm Splint Clinic Charge","code_information":[{"code":"29125","type":"CDM"},{"code":"521","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"29130 Applic Of Finger Splint; Static Charge","code_information":[{"code":"29130","type":"CDM"},{"code":"521","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"58301 Removal Iud Clinic Charge","code_information":[{"code":"58301","type":"CDM"},{"code":"521","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Arthro, Ankle; Tibiotalar And Fibulotalar Joints","code_information":[{"code":"11900","type":"CDM"},{"code":"521","type":"RC"},{"code":"11900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Debride Of Nail(s) By Any Method(s); One To Five Tech Chg","code_information":[{"code":"11720","type":"CDM"},{"code":"521","type":"RC"},{"code":"11720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":55,"gross_charge":65,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Creatinine Clear Ur 24h Cvt","code_information":[{"code":"4302262","type":"CDM"},{"code":"301","type":"RC"},{"code":"82575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":54,"gross_charge":64,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Troponin","code_information":[{"code":"4300704","type":"CDM"},{"code":"301","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":54,"gross_charge":64,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Qual Nonmd Est Pt 1120 Minutes.","code_information":[{"code":"4389033","type":"CDM"},{"code":"441","type":"RC"},{"code":"98971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":54,"gross_charge":64,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Ventilator Circuit Zoll Vent   Adlt/pedi  (Er)","code_information":[{"code":"4273431","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273431","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":54,"gross_charge":64,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Vfc Heb B Pediatric Vaccine","code_information":[{"code":"90744","type":"CDM"},{"code":"636","type":"RC"},{"code":"90744","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Tape Hypafix 4 Roll","code_information":[{"code":"4273234","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273234","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Massage Charge Units","code_information":[{"code":"4403029","type":"CDM"},{"code":"431","type":"RC"},{"code":"97124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Ot Massage Charge Charges","code_information":[{"code":"4409017","type":"CDM"},{"code":"431","type":"RC"},{"code":"97124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Massage Charge","code_information":[{"code":"4429014","type":"CDM"},{"code":"421","type":"RC"},{"code":"97124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Massage Charge Units","code_information":[{"code":"4423029","type":"CDM"},{"code":"421","type":"RC"},{"code":"97124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Culture, Stool Cvt","code_information":[{"code":"4302297","type":"CDM"},{"code":"306","type":"RC"},{"code":"87045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Hepatitis Be Ab Cvt","code_information":[{"code":"4302405","type":"CDM"},{"code":"301","type":"RC"},{"code":"86707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Stool Culture","code_information":[{"code":"4300297","type":"CDM"},{"code":"306","type":"RC"},{"code":"87045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"99153 Moderate Sedation, Ea Add 15 Mins [Cchd]","code_information":[{"code":"49099153","type":"CDM"},{"code":"761","type":"RC"},{"code":"99153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Conscious Sedation Ea Add'l 15 Min","code_information":[{"code":"4456452","type":"CDM"},{"code":"370","type":"RC"},{"code":"99153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Hepatitis Be Ag Cvt","code_information":[{"code":"4302396","type":"CDM"},{"code":"300","type":"RC"},{"code":"87350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":54,"gross_charge":63,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Direct Ldl Cvt","code_information":[{"code":"4302442","type":"CDM"},{"code":"301","type":"RC"},{"code":"83721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":53,"gross_charge":62,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Aldolase Cvt","code_information":[{"code":"4302115","type":"CDM"},{"code":"301","type":"RC"},{"code":"82085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":53,"gross_charge":62,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Splint Masonallen Sm Each","code_information":[{"code":"4273934","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273934","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":53,"gross_charge":62,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Cerv/vag Cancer Scrn; Plvc/cln Brst Ex","code_information":[{"code":"G0101","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":52,"gross_charge":61,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Peak Flo-meter Unit Oxygn","code_information":[{"code":"4273452","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273452","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":52,"gross_charge":61,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"11103tangential Biopsy Of Skin; Each Additional Lesion","code_information":[{"code":"11103","type":"CDM"},{"code":"521","type":"RC"},{"code":"11103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":52,"gross_charge":61,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"97129 Therapeutic Intervention/cognitive Function, First 15 Min","code_information":[{"code":"CP17667781911642896","type":"CDM"},{"code":"431","type":"RC"},{"code":"97129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"97129 Ther Intervention 1st 15 Minutes","code_information":[{"code":"4380051","type":"CDM"},{"code":"441","type":"RC"},{"code":"97129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Transferrin","code_information":[{"code":"4300344","type":"CDM"},{"code":"301","type":"RC"},{"code":"84466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Bill Surgpath Lev Ii 88302","code_information":[{"code":"4306675","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Culture, Body Fluid W/gs Cvt","code_information":[{"code":"4302283","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Culture, Sputum W/gs Cvt","code_information":[{"code":"4302293","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Culture, Wound W/gs Cvt","code_information":[{"code":"4302301","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Immunoglobulin A Cvt","code_information":[{"code":"4302428","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Immunoglobulin G Cvt","code_information":[{"code":"4302430","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"T3 Reverse Cvt","code_information":[{"code":"4302917","type":"CDM"},{"code":"301","type":"RC"},{"code":"84482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Aerobic Culture","code_information":[{"code":"4300279","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Body Fluid Culture","code_information":[{"code":"4300283","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Ear Culture","code_information":[{"code":"4300305","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Eye Culture","code_information":[{"code":"4300306","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Genital Culture","code_information":[{"code":"4300289","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Nasal Culture","code_information":[{"code":"4300277","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Sputum Culture","code_information":[{"code":"4300293","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Throat Culture","code_information":[{"code":"4300295","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Wound Culture","code_information":[{"code":"4300301","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"97130 Therapeutic Intervention/cognitive Function/each Add 15 Min","code_information":[{"code":"CP17667781911645084","type":"CDM"},{"code":"431","type":"RC"},{"code":"97130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Pt Cognitive Function Minutes","code_information":[{"code":"44297130","type":"CDM"},{"code":"421","type":"RC"},{"code":"97130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"96415 Chemo/cmplx Each Ad Hr","code_information":[{"code":"4455093","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"97130 Therapeutic Interventions That Focus On Cognitive Function; Each Additional 15 Minutes (Slp)","code_information":[{"code":"CP17667781912520246","type":"CDM"},{"code":"441","type":"RC"},{"code":"97130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Slp Cog Ther Intervent, Addl 15min Units","code_information":[{"code":"43897130","type":"CDM"},{"code":"441","type":"RC"},{"code":"97130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Dressing Drawtex 4x4 In","code_information":[{"code":"4273230","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273230","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Care Management Services For Behavioral Health20 Min","code_information":[{"code":"G0507-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0507","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Walking Boot, Off The Shelf","code_information":[{"code":"L4387","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":51,"gross_charge":60,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Oxygen Mask Nebu-system Adult","code_information":[{"code":"4273921","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273921","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":50,"gross_charge":59,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Culture Anaerobic Cvt","code_information":[{"code":"4302280","type":"CDM"},{"code":"306","type":"RC"},{"code":"87075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":50,"gross_charge":59,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Chloride, Random Urine","code_information":[{"code":"4302776","type":"CDM"},{"code":"301","type":"RC"},{"code":"82436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":50,"gross_charge":59,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Chloride, Ur Cvt","code_information":[{"code":"4302715","type":"CDM"},{"code":"301","type":"RC"},{"code":"82436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":50,"gross_charge":59,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Free T4","code_information":[{"code":"4300688","type":"CDM"},{"code":"301","type":"RC"},{"code":"84439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":50,"gross_charge":59,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Unlisted Evaluation & Management Service","code_information":[{"code":"99499","type":"CDM"},{"code":"521","type":"RC"},{"code":"99499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":50,"gross_charge":59,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Oxygen Mask Infnt Md-con","code_information":[{"code":"4273983","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273983","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":50,"gross_charge":59,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Post Transfusion Type Rh","code_information":[{"code":"4300866","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Aborh","code_information":[{"code":"4300195","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Post Tr Aborh","code_information":[{"code":"4300865","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Prealbumin Cvt","code_information":[{"code":"4302718","type":"CDM"},{"code":"301","type":"RC"},{"code":"84134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Ph, Urine Cvt","code_information":[{"code":"4302591","type":"CDM"},{"code":"301","type":"RC"},{"code":"83986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"97018 Paraffin Bath Charge","code_information":[{"code":"4409008","type":"CDM"},{"code":"431","type":"RC"},{"code":"97018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"97034 Ot Contrast Bath Ea 15 Min","code_information":[{"code":"4409012","type":"CDM"},{"code":"431","type":"RC"},{"code":"97034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"97035 Ultrasound Charge","code_information":[{"code":"4409013","type":"CDM"},{"code":"431","type":"RC"},{"code":"97035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Ot Contrast Bath Charges","code_information":[{"code":"4403007","type":"CDM"},{"code":"431","type":"RC"},{"code":"97034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Paraffin Bathparaffin Bath Charge","code_information":[{"code":"4403042","type":"CDM"},{"code":"431","type":"RC"},{"code":"97018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Rsv Poc","code_information":[{"code":"87807","type":"CDM"},{"code":"306","type":"RC"},{"code":"87807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Rapid Strep Poc","code_information":[{"code":"87880","type":"CDM"},{"code":"306","type":"RC"},{"code":"87880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"97035 Phonophoresis Ea 15 Mins Const Attend","code_information":[{"code":"4429009","type":"CDM"},{"code":"421","type":"RC"},{"code":"97035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"97035 Ultrasound/15 Min Charge","code_information":[{"code":"4429008","type":"CDM"},{"code":"421","type":"RC"},{"code":"97035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Contrast Bath","code_information":[{"code":"4429007","type":"CDM"},{"code":"421","type":"RC"},{"code":"97034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Pt Contrast Bath Charges","code_information":[{"code":"4423007","type":"CDM"},{"code":"421","type":"RC"},{"code":"97034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Phonophoresis Charge","code_information":[{"code":"4423053","type":"CDM"},{"code":"421","type":"RC"},{"code":"97035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Scrn Pap Smr; Obt, Prep & Conv Cerv/vag Smear","code_information":[{"code":"Q0091","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Shoe Post-op Fem Large","code_information":[{"code":"4273570","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273570","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Shoe Post-op Fem Med","code_information":[{"code":"4273569","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273569","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Shoe Post-op Female Small","code_information":[{"code":"4273571","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273571","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Shoe Post-op Male Lrg","code_information":[{"code":"4273541","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273541","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Shoe Post-op Male Med","code_information":[{"code":"4273540","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273540","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Shoe Post-op Male X-lg","code_information":[{"code":"4273373","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273373","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":49,"gross_charge":58,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Tube Gastric Adlt/ped 28f","code_information":[{"code":"4273055","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273055","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":48,"gross_charge":57,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Vest Restraint Sm.","code_information":[{"code":"4273129","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273129","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":48,"gross_charge":57,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Ova And Parasites Smear Cvt","code_information":[{"code":"4302575","type":"CDM"},{"code":"306","type":"RC"},{"code":"87177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":48,"gross_charge":57,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Hcg Quantitative","code_information":[{"code":"4300381","type":"CDM"},{"code":"301","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":48,"gross_charge":57,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Splint Clavicle Infant","code_information":[{"code":"L3650","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":48,"gross_charge":57,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Co2 Detector Pedi Disp","code_information":[{"code":"4273286","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273286","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":48,"gross_charge":57,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Vest Restraint Lg.","code_information":[{"code":"4273122","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273122","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":48,"gross_charge":57,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Crutches Child 4'-4'6","code_information":[{"code":"4273557","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273557","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":48,"gross_charge":56,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Event Standby Per 4 Hrs","code_information":[{"code":"4530002","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":48,"gross_charge":56,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Culture, Fungus W/ Smear Cvt","code_information":[{"code":"4302285","type":"CDM"},{"code":"306","type":"RC"},{"code":"87102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":48,"gross_charge":56,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Kidney function panel test","code_information":[{"code":"4300446","type":"CDM"},{"code":"301","type":"RC"},{"code":"80069","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":48,"gross_charge":56,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Minimum Inhibitory Concentration","code_information":[{"code":"4300466","type":"CDM"},{"code":"306","type":"RC"},{"code":"87186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":48,"gross_charge":56,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Shoulder/immob/med","code_information":[{"code":"4273587","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":48,"gross_charge":56,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Shoulder/immob/x-lg","code_information":[{"code":"4273589","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":48,"gross_charge":56,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Cathetr Picc/cvc Stabilzr","code_information":[{"code":"4273940","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273940","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":48,"gross_charge":56,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Time Waiting Per 1/2 Hr","code_information":[{"code":"4531007","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":47,"gross_charge":55,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Basic metabolic panel","code_information":[{"code":"4300172","type":"CDM"},{"code":"301","type":"RC"},{"code":"80048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":47,"gross_charge":55,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Bairhug Upper Body Blankt","code_information":[{"code":"4273190","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273190","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":47,"gross_charge":55,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Ambu Bag Adlt Resusitator","code_information":[{"code":"4273564","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273564","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":47,"gross_charge":55,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Co2 Nasal/oral Adult Filtrline (Lfpak Monitr)","code_information":[{"code":"4273975","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273975","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Biopatch 1disk /W Chg 4m","code_information":[{"code":"4273959","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273959","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Tube Feeding 8fr W Stylet","code_information":[{"code":"4273119","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273119","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Bacterial Id","code_information":[{"code":"4300186","type":"CDM"},{"code":"306","type":"RC"},{"code":"87077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Anti- Parietal Cell Ab Cvt","code_information":[{"code":"4302919","type":"CDM"},{"code":"301","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Beta Hcg, Quantitative Cvt","code_information":[{"code":"4302067","type":"CDM"},{"code":"301","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Fta Antibodies Cvt","code_information":[{"code":"4302703","type":"CDM"},{"code":"302","type":"RC"},{"code":"86780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Canalith Repositioning Proc","code_information":[{"code":"95992","type":"CDM"},{"code":"521","type":"RC"},{"code":"95992","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Nasal Rocket Rhno Packing","code_information":[{"code":"4273641","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273641","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Tube Feeding 12fr Wstylet","code_information":[{"code":"4273387","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273387","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":46,"gross_charge":54,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Dressng Medihoney 80% 4x5","code_information":[{"code":"4273860","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273860","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":45,"gross_charge":53,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"H. Pylori Drug Admin","code_information":[{"code":"4300388","type":"CDM"},{"code":"301","type":"RC"},{"code":"83014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":45,"gross_charge":53,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Cholesterol High Density Lipid","code_information":[{"code":"4300365","type":"CDM"},{"code":"301","type":"RC"},{"code":"83718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":45,"gross_charge":53,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Liver function blood test","code_information":[{"code":"4300393","type":"CDM"},{"code":"301","type":"RC"},{"code":"80076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":45,"gross_charge":53,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Varicella-zoster Ab,  Igg Cvt","code_information":[{"code":"4302731","type":"CDM"},{"code":"302","type":"RC"},{"code":"86787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":45,"gross_charge":53,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Wrist Splints","code_information":[{"code":"L3908","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":45,"gross_charge":53,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Low Dose Ct Ca Screen Counseling Discuss Need","code_information":[{"code":"G0296-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0296","type":"HCPCS","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":42,"maximum":45,"gross_charge":53,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Dressing Aquacl Extra 4x5 Or Ribbon","code_information":[{"code":"4273861","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273861","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Splint Metacarpl Youth Lt","code_information":[{"code":"4273513","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Culture, Urine Cvt","code_information":[{"code":"4302712","type":"CDM"},{"code":"306","type":"RC"},{"code":"87086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"H Pylori","code_information":[{"code":"4300390","type":"CDM"},{"code":"302","type":"RC"},{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Urine Culture","code_information":[{"code":"4300299","type":"CDM"},{"code":"306","type":"RC"},{"code":"87086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Alcohol Breath Test Poc","code_information":[{"code":"82075","type":"CDM"},{"code":"301","type":"RC"},{"code":"82075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Drug Screen 10 Panel Poc","code_information":[{"code":"80305","type":"CDM"},{"code":"301","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"20550 Injection(s); Single Tendon Sheath, Or Ligament, Apo Neurosis (Eg, Plantar Fascia)","code_information":[{"code":"20550","type":"CDM"},{"code":"521","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Splint Metacarpl Youth Rt","code_information":[{"code":"4273512","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":44,"gross_charge":52,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Splint Spica Thumb Unv","code_information":[{"code":"4273413","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273413","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Bandage High Compression","code_information":[{"code":"4273954","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273954","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Scrotal Support Med","code_information":[{"code":"4273615","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273615","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"4302188","type":"CDM"},{"code":"301","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"4300188","type":"CDM"},{"code":"301","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"G0283 Ot E-stim Unattended","code_information":[{"code":"4409006","type":"CDM"},{"code":"431","type":"RC"},{"code":"97014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Unattended Electrical Therapyunattended Electrical Therapy Charge","code_information":[{"code":"4403010","type":"CDM"},{"code":"431","type":"RC"},{"code":"97014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Pt E-stim Unattended","code_information":[{"code":"4429002","type":"CDM"},{"code":"421","type":"RC"},{"code":"97014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Unattended Electrical Therapyunattended Electrical Therapy Charge","code_information":[{"code":"4423009","type":"CDM"},{"code":"421","type":"RC"},{"code":"97014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"29260 Strapping Elbow  Wrist","code_information":[{"code":"4453138","type":"CDM"},{"code":"761","type":"RC"},{"code":"29260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"29280 Strapping Hand  Finger","code_information":[{"code":"4453139","type":"CDM"},{"code":"761","type":"RC"},{"code":"29280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Tetanus, Diphtheria Toxoids & Acellular Pertussis Vaccine (Tdap), 7 Years Or Older, Im Use Poc","code_information":[{"code":"90715","type":"CDM"},{"code":"636","type":"RC"},{"code":"90715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Binder Abd Sm 20-35","code_information":[{"code":"4273583","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273583","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Ultrasound And Stimulation Needle 21x3 In (Painmanagement)","code_information":[{"code":"4273145","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273145","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":43,"gross_charge":51,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Oxygen Hut 18x18 Mist Tnt","code_information":[{"code":"4273052","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273052","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Dressing Heels Foam","code_information":[{"code":"4273349","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273349","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Shoulder/immob/sm","code_information":[{"code":"4273586","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Fluid/blood Warming Ranger Set 3m","code_information":[{"code":"4273455","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273455","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Cryoglobulin W/reflex If Indicated Cvt","code_information":[{"code":"4302244","type":"CDM"},{"code":"301","type":"RC"},{"code":"82595","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Cpt Subsequent","code_information":[{"code":"4413028","type":"CDM"},{"code":"412","type":"RC"},{"code":"94668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Finger O2 Sensor Pedi/adlt Mindray Disp","code_information":[{"code":"4273453","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273453","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"99450 Basic Life And/or Disablity Examination","code_information":[{"code":"99450","type":"CDM"},{"code":"521","type":"RC"},{"code":"99450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Bicillin La 600,000uni","code_information":[{"code":"J0561","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":43,"gross_charge":50,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Cath Coude 16fr 5cc","code_information":[{"code":"4273544","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273544","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Cath Coude 18fr 5cc","code_information":[{"code":"4273545","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273545","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Cath Coude 20fr 5cc","code_information":[{"code":"4273546","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273546","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Electrolyte Panel Standard","code_information":[{"code":"4300325","type":"CDM"},{"code":"301","type":"RC"},{"code":"80051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Ketones Cvt","code_information":[{"code":"4302105","type":"CDM"},{"code":"301","type":"RC"},{"code":"82009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Uric Acid, Synovial Fluid Cvt","code_information":[{"code":"4302071","type":"CDM"},{"code":"300","type":"RC"},{"code":"84560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Uric Acid, Ur Cvt","code_information":[{"code":"4302711","type":"CDM"},{"code":"301","type":"RC"},{"code":"84560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Dressing Prisma 4.34 Sq.in","code_information":[{"code":"4273162","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273162","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Binder Abd Sm-med 30-45","code_information":[{"code":"4273584","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273584","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Belt Rib Female Universal","code_information":[{"code":"4273301","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273301","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Belt Rib Male Universal","code_information":[{"code":"4273300","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Co2 Detector Adult Disp","code_information":[{"code":"4273289","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273289","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Packing Rapid Rhino","code_information":[{"code":"A4649","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":42,"gross_charge":49,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"86696 Antibody; Herpes Simplex, Type 2","code_information":[{"code":"4302055","type":"CDM"},{"code":"302","type":"RC"},{"code":"86696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":41,"gross_charge":48,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"T3, Uptake Cvt","code_information":[{"code":"4302680","type":"CDM"},{"code":"301","type":"RC"},{"code":"84479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":41,"gross_charge":48,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Influenza Virus Vaccine, Splie Virus, Preservative Free, For Children 6-35 Months Of Age, Im Poc","code_information":[{"code":"90685","type":"CDM"},{"code":"636","type":"RC"},{"code":"90685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":41,"gross_charge":48,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Scrotal Support Lg","code_information":[{"code":"4273616","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273616","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":41,"gross_charge":48,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Dressing Mepilex 8x4 /W Border","code_information":[{"code":"4273409","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273409","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":41,"gross_charge":48,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Scrotal Support Sm","code_information":[{"code":"4273614","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273614","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":40,"gross_charge":47,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Removal Impacted Cerumen, Irrigation/lavage","code_information":[{"code":"69209","type":"CDM"},{"code":"521","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":40,"gross_charge":47,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"99453 Telehealth Rem Monitor Physiol Param Setup Charge","code_information":[{"code":"99453","type":"CDM"},{"code":"521","type":"RC"},{"code":"99453","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":40,"gross_charge":47,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Crystals, Fl Cvt","code_information":[{"code":"4302250","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":39,"gross_charge":46,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Gamma Glutamyl Transferase","code_information":[{"code":"4300373","type":"CDM"},{"code":"301","type":"RC"},{"code":"82977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":39,"gross_charge":46,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Rheumatoid  Factor Cvt","code_information":[{"code":"4302640","type":"CDM"},{"code":"302","type":"RC"},{"code":"86431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":39,"gross_charge":46,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Mrsa Screen Culture","code_information":[{"code":"4300278","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":39,"gross_charge":46,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Strep Confirmation","code_information":[{"code":"4300275","type":"CDM"},{"code":"306","type":"RC"},{"code":"87081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":39,"gross_charge":46,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Troponin I High Sensitivity","code_information":[{"code":"43084484","type":"CDM"},{"code":"301","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":39,"gross_charge":46,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Co2 Intubated Adlt/pedi Filterline Set","code_information":[{"code":"4273809","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273809","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Acetaminophen Level","code_information":[{"code":"4300105","type":"CDM"},{"code":"301","type":"RC"},{"code":"80329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Lipase Level","code_information":[{"code":"4300443","type":"CDM"},{"code":"301","type":"RC"},{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Salicylate Level","code_information":[{"code":"4300649","type":"CDM"},{"code":"301","type":"RC"},{"code":"80329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Sam Spline 36 (Ems)","code_information":[{"code":"4273133","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273133","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Sam Splint 18 (Ems)","code_information":[{"code":"4273134","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273134","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"External Catheter Female","code_information":[{"code":"4273111","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Splint Metacarpl Rt Adlt","code_information":[{"code":"4273511","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Tray Cath Foley 16fr W/bg","code_information":[{"code":"4273944","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273944","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Ted Hose Knee-hi Reg 2xl","code_information":[{"code":"4273063","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273063","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":38,"gross_charge":45,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"G0136 Sdoh Assessment","code_information":[{"code":"G0136","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":37,"gross_charge":44,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Iron","code_information":[{"code":"4300425","type":"CDM"},{"code":"301","type":"RC"},{"code":"83540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":37,"gross_charge":44,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"T4 Thyroxine","code_information":[{"code":"4300681","type":"CDM"},{"code":"301","type":"RC"},{"code":"84436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":37,"gross_charge":44,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Dressing Alginate Maxorb 4x4","code_information":[{"code":"4273110","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273110","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":37,"gross_charge":44,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Fecal Fat Cvt","code_information":[{"code":"4302745","type":"CDM"},{"code":"301","type":"RC"},{"code":"82705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":37,"gross_charge":43,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Magnesium Level","code_information":[{"code":"4300459","type":"CDM"},{"code":"301","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":37,"gross_charge":43,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Tray Lumbar Adult 22g 3.5","code_information":[{"code":"4273238","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273238","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":37,"gross_charge":43,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Airway Co2 Adapter Zoll","code_information":[{"code":"4273159","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273159","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":37,"gross_charge":43,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Amylase Level","code_information":[{"code":"4300125","type":"CDM"},{"code":"301","type":"RC"},{"code":"82150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":36,"gross_charge":42,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Complete blood cell count (CBC), automated","code_information":[{"code":"4300189","type":"CDM"},{"code":"301","type":"RC"},{"code":"85027","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":36,"gross_charge":42,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Creatine Kinase","code_information":[{"code":"4300261","type":"CDM"},{"code":"301","type":"RC"},{"code":"82550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":36,"gross_charge":42,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Lithium Cvt","code_information":[{"code":"4302453","type":"CDM"},{"code":"301","type":"RC"},{"code":"80178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":36,"gross_charge":42,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Phosphorus, Ur Cvt","code_information":[{"code":"4302601","type":"CDM"},{"code":"301","type":"RC"},{"code":"84105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":36,"gross_charge":42,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Collar Foam Adult Cervical","code_information":[{"code":"4273073","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":35,"gross_charge":41,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Sars-cov-2 (Covid-19) Antigen","code_information":[{"code":"4307001","type":"CDM"},{"code":"306","type":"RC"},{"code":"87811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":35,"gross_charge":41,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Sars-cov-2 (Covid-19) Antigen Pmho","code_information":[{"code":"87811","type":"CDM"},{"code":"306","type":"RC"},{"code":"87811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":35,"gross_charge":41,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Splint Metacarpl Lft Adlt","code_information":[{"code":"4273510","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":35,"gross_charge":41,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Urine Pregnancy Test","code_information":[{"code":"4300379","type":"CDM"},{"code":"307","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":35,"gross_charge":41,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Telehealth Audio-video, 60 Min, New Pt","code_information":[{"code":"Q3014","type":"CDM"},{"code":"780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":35,"gross_charge":41,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Lorazepam Injection","code_information":[{"code":"J2060","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":35,"gross_charge":41,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Urine Pregnancy Test Poc","code_information":[{"code":"81025","type":"CDM"},{"code":"521","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":35,"gross_charge":41,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Belt Rib Male X-lg","code_information":[{"code":"4273071","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273071","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Binder Abd Med/lg 46-62","code_information":[{"code":"4273585","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273585","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Inhibin-a","code_information":[{"code":"4302421","type":"CDM"},{"code":"302","type":"RC"},{"code":"86336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Creatine Kinase-mb","code_information":[{"code":"4300259","type":"CDM"},{"code":"301","type":"RC"},{"code":"82553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Hemoglobin A1c Poc","code_information":[{"code":"83036","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"J1750 Iron Dextran Inj, 50 Mg","code_information":[{"code":"J1750","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"94640 Inhalation Treatment For Acute Airway Obstruction Or Sputum Induction For Diagnostic Purposes","code_information":[{"code":"94640","type":"CDM"},{"code":"521","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Bronchodilation Responsiveness, Spirometry Pre And Post Bronchodilator Admin Charge","code_information":[{"code":"94060","type":"CDM"},{"code":"521","type":"RC"},{"code":"94060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Collar Philadelph Lg","code_information":[{"code":"4273195","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Collar Philadelph Med","code_information":[{"code":"4273196","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Collar Philadelph Small","code_information":[{"code":"4273197","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Cautery/battery Operated","code_information":[{"code":"4273309","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273309","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Dressing Packng 2x5' Iodoform","code_information":[{"code":"4273038","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Tape Medipore 4x10yd","code_information":[{"code":"4273695","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273695","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":34,"gross_charge":40,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Dressing Mepilex 4x4 Bordr","code_information":[{"code":"4273118","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":33,"gross_charge":39,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"4300591","type":"CDM"},{"code":"301","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":33,"gross_charge":39,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Calcium, Ur 24hr Cvt","code_information":[{"code":"4302207","type":"CDM"},{"code":"301","type":"RC"},{"code":"82340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":33,"gross_charge":39,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Rheumatoid Factor","code_information":[{"code":"4300635","type":"CDM"},{"code":"302","type":"RC"},{"code":"86430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":33,"gross_charge":39,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Insert Foley Cath Clinic Chg","code_information":[{"code":"51702","type":"CDM"},{"code":"521","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":33,"gross_charge":39,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Suture / Laceration Disp Tray Er / Mcd","code_information":[{"code":"4273542","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273542","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":33,"gross_charge":39,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Cath Female 5fr Pedi Speci Kit","code_information":[{"code":"4273045","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":33,"gross_charge":39,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Oxygen Breath Aero Eclips","code_information":[{"code":"4273088","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273088","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Bp Cuf Disp W/a Child  Sz 9","code_information":[{"code":"4273446","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273446","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Splint Coll Med-lft","code_information":[{"code":"4273598","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273598","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Splint Coll Med-rt","code_information":[{"code":"4273597","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273597","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Splint Coll Sm-lt","code_information":[{"code":"4273600","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273600","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Splint Coll Sm-rt","code_information":[{"code":"4273599","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273599","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Splint Coll Xsm Child Lft","code_information":[{"code":"4273345","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273345","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Splint Coll Xsm Child Rt","code_information":[{"code":"4273343","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273343","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Bf Lactate Dehydrogenase Cvt","code_information":[{"code":"4302437","type":"CDM"},{"code":"301","type":"RC"},{"code":"83615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Lactate Dehydrogenase Total Cvt","code_information":[{"code":"4302426","type":"CDM"},{"code":"301","type":"RC"},{"code":"83615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Triglycerides","code_information":[{"code":"4300701","type":"CDM"},{"code":"301","type":"RC"},{"code":"84478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Splint Coll Lg-lt","code_information":[{"code":"4273596","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273596","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Splint Coll Lg-rt","code_information":[{"code":"4273595","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273595","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Knee/immob/12-14 Pedi","code_information":[{"code":"4273870","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273870","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"99408 Alcohol Substance Screen 15-30 Minutes","code_information":[{"code":"99408-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99408","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Heel Elbow Mesh Protector","code_information":[{"code":"4273044","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273044","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Tracheostomy Care Set","code_information":[{"code":"4273161","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273161","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Bougie Et 15fr Introducer Adult","code_information":[{"code":"4273922","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273922","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Restraint Wrist   Pr","code_information":[{"code":"4273076","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273076","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":32,"gross_charge":38,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Ted Hose Xlg Long","code_information":[{"code":"4273582","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273582","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Dressing Mepitel 3x4","code_information":[{"code":"4273043","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Dressing Allevyn 4x4 Adhes","code_information":[{"code":"4273681","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273681","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Collar Stifnec Pedi/chld","code_information":[{"code":"4273841","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273841","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Eye Press Patch","code_information":[{"code":"4273104","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273104","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Knee/immob/10-12sm Child","code_information":[{"code":"4273239","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273239","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Cell Count, Fluid Cvt","code_information":[{"code":"4302221","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Crutches Underarm, Other Than Wood, Adj./fixed, Pair, W/pads/tips/handgrips Charge","code_information":[{"code":"E0114","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Tray Lum Pun 22g 1.5 Pedi","code_information":[{"code":"4273236","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273236","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Tray Centrl Line Dressng","code_information":[{"code":"4273288","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273288","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Chest Tube Cath 24fr","code_information":[{"code":"4273424","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273424","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Belt Gait Long","code_information":[{"code":"4273312","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273312","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Belt Gait Reg.","code_information":[{"code":"4273311","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273311","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Bp Cuf Disp Dtsc/mndray Child","code_information":[{"code":"4273450","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273450","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Bp Cuf Disp Dtsc/mndray Lng Adlt","code_information":[{"code":"4273447","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273447","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":31,"gross_charge":37,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Hemovac Jacksn Prat 100ml","code_information":[{"code":"4273138","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273138","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Tube Salem Sump 16fr Ea","code_information":[{"code":"4273626","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273626","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Qual Nonmd Est Pt  5-10 Minutes.","code_information":[{"code":"4389034","type":"CDM"},{"code":"431","type":"RC"},{"code":"98970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Cath Foley 8 Fr 3cc","code_information":[{"code":"4273257","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273257","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Cath Foley 14fr 5cc","code_information":[{"code":"4273463","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273463","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Microalbumin, Ur Qn Cvt","code_information":[{"code":"4302162","type":"CDM"},{"code":"307","type":"RC"},{"code":"82043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Alkaline Phosphatase","code_information":[{"code":"4300121","type":"CDM"},{"code":"301","type":"RC"},{"code":"84075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Oxygen Open Aerosol Mask","code_information":[{"code":"4273062","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273062","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"99401 Preventive Medicine Counseling, 15 Min","code_information":[{"code":"99401-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99401","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Counseling Risk Factor Intervention 15 Min","code_information":[{"code":"48099401","type":"CDM"},{"code":"521","type":"RC"},{"code":"99401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Cath Foley 18fr 30cc  Silicone","code_information":[{"code":"4273485","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273485","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Tube Salem Sump 14fr Ea","code_information":[{"code":"4273625","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273625","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":31,"gross_charge":36,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Ostomy Belt Lg Ea","code_information":[{"code":"4273171","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273171","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Multiple-family Group Psychotherapy","code_information":[{"code":"90849","type":"CDM"},{"code":"915","type":"RC"},{"code":"90849","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Group psychotherapy","code_information":[{"code":"90853","type":"CDM"},{"code":"900","type":"RC"},{"code":"90853","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Post-transfusion Reaction Absc","code_information":[{"code":"4300867","type":"CDM"},{"code":"300","type":"RC"},{"code":"86885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Alanine Aminotransferase","code_information":[{"code":"4300695","type":"CDM"},{"code":"301","type":"RC"},{"code":"84460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Ph, Fluid Cvt","code_information":[{"code":"4302596","type":"CDM"},{"code":"301","type":"RC"},{"code":"83986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Cpap Tubing 6' /W Rubber Cuffs","code_information":[{"code":"4273393","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273393","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Dressing Hydrocoloid Sacrum","code_information":[{"code":"4273265","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273265","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"G0442 Alcohol Misuse Annual Screening","code_information":[{"code":"G0442","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"G0444 Medicare Annual Depression Screening","code_information":[{"code":"G0444-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0444","type":"HCPCS","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"G0447 Obesity Counseling","code_information":[{"code":"G0447","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Smoking And Tobacco-use Cessation Counseling Visit; Intensive, Greater Than 10 Minutes","code_information":[{"code":"99407","type":"CDM"},{"code":"521","type":"RC"},{"code":"99407","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Cath Coude 14fr 5cc","code_information":[{"code":"A4340","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Splint Sply Shrt Leg Adlt Fbgl","code_information":[{"code":"Q4046","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Chest Tube Cath 40fr","code_information":[{"code":"4273429","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273429","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Splint Clavcl Sm","code_information":[{"code":"4273505","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273505","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Urinal Holder Bedside Mnt","code_information":[{"code":"4273292","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273292","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":30,"gross_charge":35,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Bougie Et 10fr Introducer","code_information":[{"code":"4273920","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273920","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Collar Stifnec Infnt Cerv","code_information":[{"code":"4273842","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273842","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Ionized Calcium Level","code_information":[{"code":"43082330","type":"CDM"},{"code":"301","type":"RC"},{"code":"82330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Bilirubin, Direct","code_information":[{"code":"4300175","type":"CDM"},{"code":"301","type":"RC"},{"code":"82248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Reference Dat","code_information":[{"code":"4302540","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Aspartate Aminotransferase","code_information":[{"code":"4300697","type":"CDM"},{"code":"301","type":"RC"},{"code":"84450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Bilirubin Total","code_information":[{"code":"4300179","type":"CDM"},{"code":"301","type":"RC"},{"code":"82247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Bilirubin, Direct Cvt","code_information":[{"code":"4302176","type":"CDM"},{"code":"301","type":"RC"},{"code":"82248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Bilirubin, Total Cvt","code_information":[{"code":"4302175","type":"CDM"},{"code":"301","type":"RC"},{"code":"82247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"C-reactive Protein Infection","code_information":[{"code":"4300203","type":"CDM"},{"code":"302","type":"RC"},{"code":"86140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Mononucleosis Screen","code_information":[{"code":"4300465","type":"CDM"},{"code":"302","type":"RC"},{"code":"86308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Monospot Poc","code_information":[{"code":"86308","type":"CDM"},{"code":"306","type":"RC"},{"code":"86308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Dressing Hydrofera Blue Foam 4x5 /C Border","code_information":[{"code":"4273030","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Debridement Kit (Sharp Ea)","code_information":[{"code":"4273053","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273053","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":29,"gross_charge":34,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Dressing Sacrum (Allvyn/optfoam)","code_information":[{"code":"4273674","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273674","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Dressing Pl Packng 2x5","code_information":[{"code":"4273499","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273499","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Splint Wrist Rt/lft Univrsal","code_information":[{"code":"4273399","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Creatinine","code_information":[{"code":"4300264","type":"CDM"},{"code":"301","type":"RC"},{"code":"82565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Creatinine, Ur Cvt","code_information":[{"code":"4302721","type":"CDM"},{"code":"301","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Immun Adm Each Add Vaccin","code_information":[{"code":"4453196","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Creatinine, Ur","code_information":[{"code":"4300026","type":"CDM"},{"code":"301","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Creatinine, Ur","code_information":[{"code":"4302778","type":"CDM"},{"code":"301","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Osmolality, Ser Cvt","code_information":[{"code":"4302583","type":"CDM"},{"code":"301","type":"RC"},{"code":"83930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Creatinine, Urine Poc","code_information":[{"code":"82570","type":"CDM"},{"code":"301","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Urine Microalbumin/creatinine Poc","code_information":[{"code":"82044","type":"CDM"},{"code":"301","type":"RC"},{"code":"8204482570","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cpap Vent Circuit","code_information":[{"code":"4273375","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273375","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Dressing Aquacl  Ag 4x4 Adhsv","code_information":[{"code":"4273281","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273281","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Collar Foam X-sm Cervical","code_information":[{"code":"4273260","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273260","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Dressing Iodoflex 5x5g Pad","code_information":[{"code":"4273354","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273354","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Stat Lock Picc","code_information":[{"code":"4273077","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273077","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Tray Cath Foley 18fr W/bag","code_information":[{"code":"4273966","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273966","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"96127. Brief Emotional/behavioral Assessment","code_information":[{"code":"96127-AM","type":"CDM"},{"code":"918","type":"RC"},{"code":"96127","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Development Test Limit","code_information":[{"code":"96110-AM","type":"CDM"},{"code":"918","type":"RC"},{"code":"96110","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":26,"maximum":28,"gross_charge":33,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Albumin Level","code_information":[{"code":"4300113","type":"CDM"},{"code":"301","type":"RC"},{"code":"82040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Calcium Level Total","code_information":[{"code":"4300211","type":"CDM"},{"code":"301","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Calcium Urine","code_information":[{"code":"4302785","type":"CDM"},{"code":"301","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Calcium, Ur Cvt","code_information":[{"code":"4302066","type":"CDM"},{"code":"301","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Carbon Dioxide Level","code_information":[{"code":"4300214","type":"CDM"},{"code":"301","type":"RC"},{"code":"82374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Osmolality, Ur Cvt","code_information":[{"code":"4302584","type":"CDM"},{"code":"301","type":"RC"},{"code":"83935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Bp Cuf Disp Dtsc/mndray Adult","code_information":[{"code":"4273448","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273448","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Diphenhydramine, Up To 50mg","code_information":[{"code":"J1200","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Promethazine Hcl Injection [Pmho]","code_information":[{"code":"J2550","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Anti-reflux Gastric Sump Valve (Argyle)","code_information":[{"code":"4273080","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273080","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Bp Cuf Disp W/a  X-lg Adult","code_information":[{"code":"4273444","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273444","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Bp Cuf Disp W/a Adult","code_information":[{"code":"4273445","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273445","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Splint Cock-up Large","code_information":[{"code":"4273253","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Splint Cock-up Med","code_information":[{"code":"4273918","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Bag Dignishield Stool Collection","code_information":[{"code":"4273008","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":27,"gross_charge":32,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Thermal Blanket 4x4 Disp","code_information":[{"code":"4273978","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273978","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Dressing Vac Drape Clear Adhesive","code_information":[{"code":"4273078","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273078","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Staple Skin 35 Shot Disp","code_information":[{"code":"4273798","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273798","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Chest Tube Cath 28fr","code_information":[{"code":"4273425","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273425","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Chest Tube Cath 32fr","code_information":[{"code":"4273426","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273426","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Chest Tube Cath 36fr","code_information":[{"code":"4273420","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273420","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Refer Handle Fee","code_information":[{"code":"4300001","type":"CDM"},{"code":"309","type":"RC"},{"code":"99001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":".Gtt 1 Hour (50gm)","code_information":[{"code":"CP17667781911298221","type":"CDM"},{"code":"CP17667781911298221","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":".Gtt-2 Hr","code_information":[{"code":"4300359","type":"CDM"},{"code":"301","type":"RC"},{"code":"82950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"D-dimer","code_information":[{"code":"4300025","type":"CDM"},{"code":"305","type":"RC"},{"code":"85379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"O'sullivan Test","code_information":[{"code":"4300856","type":"CDM"},{"code":"301","type":"RC"},{"code":"82950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Phosphorus Level","code_information":[{"code":"4300598","type":"CDM"},{"code":"301","type":"RC"},{"code":"84100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sodium Level","code_information":[{"code":"4300669","type":"CDM"},{"code":"301","type":"RC"},{"code":"84295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sodium, Ur 24hr Quant Cvt","code_information":[{"code":"4302023","type":"CDM"},{"code":"301","type":"RC"},{"code":"84300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sodium, Ur Cvt","code_information":[{"code":"4302723","type":"CDM"},{"code":"301","type":"RC"},{"code":"84300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Handling And/or Conveyance Of Specimen For Transfer From The","code_information":[{"code":"99001","type":"CDM"},{"code":"309","type":"RC"},{"code":"99001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Carboxyhemoglobin.","code_information":[{"code":"43082375","type":"CDM"},{"code":"301","type":"RC"},{"code":"82375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Splint Cock-up Small","code_information":[{"code":"4273656","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Cath Tray Foley W/out Balloon","code_information":[{"code":"4273064","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273064","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":26,"gross_charge":31,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Cath Foley 24fr 5cc","code_information":[{"code":"4273468","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273468","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Chest Tube Cath 16fr","code_information":[{"code":"4273422","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273422","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Bill Surgpath Lev I 88300","code_information":[{"code":"4306674","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Chloride Level","code_information":[{"code":"4300228","type":"CDM"},{"code":"301","type":"RC"},{"code":"82435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Microalb/creat Ratio","code_information":[{"code":"4300114","type":"CDM"},{"code":"301","type":"RC"},{"code":"82044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Potassium Level","code_information":[{"code":"4300609","type":"CDM"},{"code":"301","type":"RC"},{"code":"84132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Rapid Plasma Reagin Cvt","code_information":[{"code":"4302661","type":"CDM"},{"code":"302","type":"RC"},{"code":"86592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Uric Acid","code_information":[{"code":"4300709","type":"CDM"},{"code":"301","type":"RC"},{"code":"84550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Poc Hemoglobin/hct","code_information":[{"code":"85018","type":"CDM"},{"code":"307","type":"RC"},{"code":"8501885014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cath Foley 18fr 5cc","code_information":[{"code":"4273465","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273465","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"99000 Handling And/or Conveyance Of Specimen For Transfer From The Office To A Laboratory","code_information":[{"code":"99000-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99000","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"90656 Private Influenza 6mnths And Older Trivalent [Cchd]","code_information":[{"code":"90656-AM","type":"CDM"},{"code":"636","type":"RC"},{"code":"90656","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cath Foley 22fr 5cc","code_information":[{"code":"4273467","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273467","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Tape Medipore 3x10yd","code_information":[{"code":"4273694","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273694","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Ted Hose Lg Short","code_information":[{"code":"4273574","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273574","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Dressing Colagen Puracol Dressing","code_information":[{"code":"4273283","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273283","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":26,"gross_charge":30,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sling Arm Xlg","code_information":[{"code":"4273308","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273308","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Ted Stocking Knee Ex Large","code_information":[{"code":"4273264","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273264","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Cath Foley 16fr 5cc","code_information":[{"code":"4273464","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273464","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Gram Stain Cvt","code_information":[{"code":"4302737","type":"CDM"},{"code":"306","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Platelet Count","code_information":[{"code":"4300605","type":"CDM"},{"code":"305","type":"RC"},{"code":"85049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Gram Stain Report","code_information":[{"code":"4300377","type":"CDM"},{"code":"306","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Oxygen Aerochamber Spacer Device","code_information":[{"code":"4273140","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273140","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Cath Foley 10fr 3cc","code_information":[{"code":"4273258","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273258","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Ear Wicks Sterile Pkg/5","code_information":[{"code":"4273974","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273974","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Cast Shoe Meds","code_information":[{"code":"L3260","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":25,"gross_charge":29,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Dressing Packng 1x5' Iodofrm","code_information":[{"code":"4273037","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Cath Strap Leg Holder","code_information":[{"code":"4273007","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Micro Add-on","code_information":[{"code":"4300300","type":"CDM"},{"code":"306","type":"RC"},{"code":"87046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":".Rapid Plasma Reagin, Titer Cvt","code_information":[{"code":"4302637","type":"CDM"},{"code":"302","type":"RC"},{"code":"86593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Cholesterol Total","code_information":[{"code":"4300231","type":"CDM"},{"code":"301","type":"RC"},{"code":"82465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Potassium, Ur Cvt","code_information":[{"code":"4302717","type":"CDM"},{"code":"301","type":"RC"},{"code":"84133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Reticulocyte Count, Auto. Cvt","code_information":[{"code":"4302633","type":"CDM"},{"code":"300","type":"RC"},{"code":"85045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Injection, Vitamin B-12 Cyanocobalamin, Up To 1000 Mcg Charge","code_information":[{"code":"J3420","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Felt U-shaped Lesion Pad","code_information":[{"code":"4273131","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273131","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Sling Med.humerus/shoulder Med","code_information":[{"code":"4273307","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273307","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Sling Humerus Shoulder Large","code_information":[{"code":"A4565","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":24,"gross_charge":28,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Splint Clavcl Lg","code_information":[{"code":"4273507","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273507","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Splint Clavcl Med","code_information":[{"code":"4273506","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273506","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Splint Clavcl Pedi-infant","code_information":[{"code":"4273509","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273509","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Splint Clavcl Xlg","code_information":[{"code":"4273508","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273508","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Bandage Unna Boot 3","code_information":[{"code":"4273363","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273363","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Kit Enteral Feeding Set","code_information":[{"code":"4273374","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273374","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Ted Hose Sm Long","code_information":[{"code":"4273578","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273578","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Cath Male Extrnal Texas","code_information":[{"code":"4273005","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Fecal Wbc","code_information":[{"code":"4300748","type":"CDM"},{"code":"309","type":"RC"},{"code":"89055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Glucose, Csf Cvt","code_information":[{"code":"4302369","type":"CDM"},{"code":"301","type":"RC"},{"code":"82945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Sam Splint 9 (Ems)","code_information":[{"code":"4273132","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273132","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Heel Protector Foam/fur","code_information":[{"code":"4273072","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273072","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Staple Skin 35w Disp Ea","code_information":[{"code":"4273799","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273799","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Pad Gaymar Temp-pad Dispzzz","code_information":[{"code":"4273001","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":23,"gross_charge":27,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Urine Meter","code_information":[{"code":"4273229","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273229","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Trap Mucous 40cc Disp Ea","code_information":[{"code":"4273010","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Bun/creat Ratio","code_information":[{"code":"4300705","type":"CDM"},{"code":"301","type":"RC"},{"code":"84520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Glucose Fasting","code_information":[{"code":"4300367","type":"CDM"},{"code":"301","type":"RC"},{"code":"82947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"4300627","type":"CDM"},{"code":"301","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Electronic Analysis Of Implanted Neurostimulator Pulse Gener","code_information":[{"code":"17003","type":"CDM"},{"code":"521","type":"RC"},{"code":"17003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Cleanser Dermal Wound","code_information":[{"code":"4273478","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273478","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Ted Hose Lg Long","code_information":[{"code":"4273580","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273580","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Ted Hose Lg Reg","code_information":[{"code":"4273577","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273577","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Ted Hose Med Long","code_information":[{"code":"4273579","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273579","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Ted Hose Xlg Reg","code_information":[{"code":"4273581","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273581","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Vent Filter Zoll Endotrach & Ventilator             Humid-vent Filter","code_information":[{"code":"4273418","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273418","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":22,"gross_charge":26,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Bairhug Blankt Full Body","code_information":[{"code":"4273866","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273866","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ted Hose Med Reg","code_information":[{"code":"4273576","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273576","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ted Hose Med Short","code_information":[{"code":"4273573","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273573","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ted Hose Sm Reg","code_information":[{"code":"4273575","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273575","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ted Hose Sm Short","code_information":[{"code":"4273572","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273572","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Thermal Blanket 4x7 Disp","code_information":[{"code":"4273440","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273440","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Esophageal/rectal Temp Probe (Er)","code_information":[{"code":"4273144","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273144","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ea Add Gtt Specimen","code_information":[{"code":"4300357","type":"CDM"},{"code":"301","type":"RC"},{"code":"82952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Nbs Collection Fee","code_information":[{"code":"4300007","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Thaw Fee","code_information":[{"code":"4300198","type":"CDM"},{"code":"300","type":"RC"},{"code":"86927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Total Protein, Body Fl Cvt","code_information":[{"code":"4302625","type":"CDM"},{"code":"301","type":"RC"},{"code":"84157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"L1830 Immobilizer Knee 20 Med","code_information":[{"code":"L1830","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Short Arm Splint Plaster Adult 11 Yrs Plus","code_information":[{"code":"Q4021","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Dressing Allevyn 3x3 Adh","code_information":[{"code":"4273680","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273680","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":21,"gross_charge":25,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Aerogen Adult Tee Nebulizer","code_information":[{"code":"4273128","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273128","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Protein/creatinine Ratio, Ur Cvt","code_information":[{"code":"4302104","type":"CDM"},{"code":"301","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Sed Rate (Esr)","code_information":[{"code":"4300651","type":"CDM"},{"code":"305","type":"RC"},{"code":"85651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Sedimentation Rate Automated","code_information":[{"code":"4400027","type":"CDM"},{"code":"305","type":"RC"},{"code":"85652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Total Protein, Ur 24hr Quant Cvt","code_information":[{"code":"4302103","type":"CDM"},{"code":"301","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Tube Et Holder Pedi Disp","code_information":[{"code":"4273398","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273398","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Urinary Drainag Bag 2000c","code_information":[{"code":"4273227","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273227","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Collar Cervical Each","code_information":[{"code":"L0120","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Dressing Pl Packng 1x5'","code_information":[{"code":"4273498","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273498","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Arm Board Pedi / Inft Dsp","code_information":[{"code":"4273175","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273175","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":20,"gross_charge":24,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Splint","code_information":[{"code":"A4570","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Tube Et Holder Adult Disp","code_information":[{"code":"4273397","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273397","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Psa Total Cvt","code_information":[{"code":"4302623","type":"CDM"},{"code":"301","type":"RC"},{"code":"84155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Protein Total","code_information":[{"code":"4300623","type":"CDM"},{"code":"301","type":"RC"},{"code":"84155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Hemoccult Poc","code_information":[{"code":"82270","type":"CDM"},{"code":"301","type":"RC"},{"code":"82270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Stool For Occult Blood Poc","code_information":[{"code":"82272","type":"CDM"},{"code":"301","type":"RC"},{"code":"82272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Room/bed: Observation Special Equipment","code_information":[{"code":"4460007","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Cast Sply Lng Arm Cst Adlt Fbgl","code_information":[{"code":"Q4006","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Tube Salem Sump 18 Fr Ea","code_information":[{"code":"4273627","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273627","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":20,"gross_charge":23,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Ted Stocking Knee Lg.reg.","code_information":[{"code":"4273364","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273364","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Sling Arm Large","code_information":[{"code":"4273302","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273302","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Sling Arm Med","code_information":[{"code":"4273303","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273303","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Bill Venipuncture Fee","code_information":[{"code":"4300004","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Cath For Clct Spcm Sgl Pt Charge","code_information":[{"code":"4453210","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Venipuncture Charge","code_information":[{"code":"36415","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Manual Differential","code_information":[{"code":"4300190","type":"CDM"},{"code":"305","type":"RC"},{"code":"85007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Ekg With Ippe, Tracing","code_information":[{"code":"G0404","type":"CDM"},{"code":"730","type":"RC"},{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Sling Arm Small","code_information":[{"code":"4273304","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273304","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Tray Cath Foley 16fr W/bag","code_information":[{"code":"A4314","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":19,"gross_charge":22,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Dressing Adhsv Optifoam/allevyn 4x4 Adhsv","code_information":[{"code":"4273675","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273675","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Ua Micro Standard","code_information":[{"code":"4300717","type":"CDM"},{"code":"307","type":"RC"},{"code":"81015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"4300710","type":"CDM"},{"code":"301","type":"RC"},{"code":"81001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"4300713","type":"CDM"},{"code":"301","type":"RC"},{"code":"81001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"81000","type":"CDM"},{"code":"301","type":"RC"},{"code":"81000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"81001","type":"CDM"},{"code":"301","type":"RC"},{"code":"81001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"High Flow Oxygen","code_information":[{"code":"4273101","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273101","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Dressing Packng 1/2iodoform","code_information":[{"code":"4273036","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Splint Finger Frog","code_information":[{"code":"4273603","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273603","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Methemoglobin Percent","code_information":[{"code":"43083050","type":"CDM"},{"code":"301","type":"RC"},{"code":"83050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":18,"gross_charge":21,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Dressing Packng.25x Iodoform","code_information":[{"code":"4273035","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Naso 16fr 5.3mm","code_information":[{"code":"4273835","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273835","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Occult Blood Gastric Fluid","code_information":[{"code":"4300358","type":"CDM"},{"code":"301","type":"RC"},{"code":"82271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Room/bed: Observation","code_information":[{"code":"4460002","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"93010ekg 12 Lead Interp & Report (Prof) -Clinic","code_information":[{"code":"93010","type":"CDM"},{"code":"521","type":"RC"},{"code":"93010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"96372  Therapeutic; Prophylactic, Or Diagnostic Injection, Subcutaneous Or Intramuscular","code_information":[{"code":"96372","type":"CDM"},{"code":"521","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"96380 Administration Of Respiratory Syncytial Virus, Monoclonal Antibody, Seasonal Dose By Intramusc","code_information":[{"code":"96380-AM","type":"CDM"},{"code":"771","type":"RC"},{"code":"96380","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"96381 Administration Of Respiratory Syncytial Virus, Monoclonal Antibody, Seasonal Dose By Intramusc","code_information":[{"code":"96381-AM","type":"CDM"},{"code":"771","type":"RC"},{"code":"96381","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"99499 Dot Physical","code_information":[{"code":"99499S","type":"CDM"},{"code":"521","type":"RC"},{"code":"99499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Budesonide 0.25mg","code_information":[{"code":"J7626","type":"CDM"},{"code":"250","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Butorphanol Tartrate 1 Mg","code_information":[{"code":"J0595","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Inj Enoxaparin Sodium","code_information":[{"code":"J1650","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Injection, Ceftriaxone Sodium, Per 250 Mg","code_information":[{"code":"J0696","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Ketorolac Trom 30mg Im","code_information":[{"code":"J1885","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"G0008 Administration Of Flu Vaccine","code_information":[{"code":"G0008","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"G0009 Administration Of Pneumonia Vaccine","code_information":[{"code":"G0009","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"G0010 Admin Hepatitis B Vaccine","code_information":[{"code":"G0010","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Cast Sply Lng Arm Cst Ped Fbgl","code_information":[{"code":"Q4008","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Splint Sply Lng Arm Splt Adlt Fbgl","code_information":[{"code":"Q4018","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Naso 12fr 4.0mm","code_information":[{"code":"4273829","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273829","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Bag Douche Disp Ea","code_information":[{"code":"4273142","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273142","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Tube Salem Sump/10fr","code_information":[{"code":"4273099","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273099","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Naso 24fr 8.0mm","code_information":[{"code":"4273551","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273551","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Naso 32fr 10.7mm","code_information":[{"code":"4273555","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273555","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Naso 34fr 8.5 Disp","code_information":[{"code":"4273556","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273556","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":17,"gross_charge":20,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Tube Feed/stomch 10fr","code_information":[{"code":"4273130","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273130","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Prochlorperazine Injection","code_information":[{"code":"J0780","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Airway Naso 18fr 6.0mm","code_information":[{"code":"4273831","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273831","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Tape Medi 3 X 10yd","code_information":[{"code":"A4450","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Needle Huber 20g 3/4","code_information":[{"code":"4273369","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273369","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Airway Naso 20fr 6.7mm","code_information":[{"code":"4273833","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273833","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Blade Clipper Surgical","code_information":[{"code":"4273451","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273451","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Suction Little Suckers","code_information":[{"code":"4273904","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273904","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Needle Chest Decomprs 14ga 2 Or 3.25","code_information":[{"code":"4273199","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273199","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Dressing Pl Packng .25x5","code_information":[{"code":"4273496","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273496","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Airway Naso 36fr","code_information":[{"code":"4273919","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273919","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":16,"gross_charge":19,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Dressing Pl Packng .5x5'","code_information":[{"code":"4273497","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273497","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Dressing Transparent 8x12","code_information":[{"code":"4273428","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273428","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Roam Alert Bracelet Strap To Cvl System","code_information":[{"code":"4273371","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273371","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Oxygen Mask Venturi","code_information":[{"code":"4273992","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273992","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Ted Stocking Knee Med.reg.","code_information":[{"code":"4273182","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273182","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Smoking And Tobacco-use Cessation Counseling Visit 10 Min","code_information":[{"code":"99406","type":"CDM"},{"code":"521","type":"RC"},{"code":"99406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Airway Naso 14fr 4.7mm","code_information":[{"code":"4273830","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273830","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Airway Naso 22fr 7.3mm","code_information":[{"code":"4273834","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273834","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Airway Naso 26fr 8.7mm","code_information":[{"code":"4273552","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273552","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Airway Naso 30fr 10.0 Mm","code_information":[{"code":"4273554","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273554","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"J1815 Injection, Insulin, Per 5 Units","code_information":[{"code":"J1815","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"J3490 Drugs Unclassified Injection","code_information":[{"code":"J3490","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Bupivacaine 0.5% 2ml","code_information":[{"code":"S0020","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Demerol 100 Mg Inj","code_information":[{"code":"J2175","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Furosemide Injection 20 Mg Charge","code_information":[{"code":"J1940","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Garamycin Gentamicin Inj","code_information":[{"code":"J1580","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Injection, Sterile Cefuroxime Sodium, Per 750 Mg","code_information":[{"code":"J0697","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"J3490*1 Exylocaine/epi 1% Inj","code_information":[{"code":"J3490*1","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"J3490*2 4.2% Sod Bicurb 10ml/5meg Inj","code_information":[{"code":"J3490*2","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"J3490*3 Xylocaine/epi 1% Inj","code_information":[{"code":"J3490*3","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"J3490*5 Xylocaine 2% 20ml/ml","code_information":[{"code":"J3490*5","type":"CDM"},{"code":"636","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Lincomycin Injection","code_information":[{"code":"J2010","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Naloxone 1 Mg","code_information":[{"code":"J2312","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"S0020*1 Bupivicaine Hci, 30ml 0.5%","code_information":[{"code":"S0020*1","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Dressing Foam Biatain Non-adhv","code_information":[{"code":"4273042","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273042","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Dressing Duoderm 4x4 Ea","code_information":[{"code":"4273280","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273280","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":15,"gross_charge":18,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Bandage Coban 6 X 5yds","code_information":[{"code":"4273051","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Staple Remover Skin","code_information":[{"code":"4273275","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273275","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Airway Naso 28fr 9.3","code_information":[{"code":"4273553","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273553","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"White Blood Count","code_information":[{"code":"4300738","type":"CDM"},{"code":"305","type":"RC"},{"code":"85048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Urinalysis test","code_information":[{"code":"81002","type":"CDM"},{"code":"301","type":"RC"},{"code":"81002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Bag/md Urinary Leg","code_information":[{"code":"A4358","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cast Sply Shrt Arm Cst Adlt Fbgl","code_information":[{"code":"Q4010","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Telemetry Pouch","code_information":[{"code":"4273365","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273365","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cushion Vinyl Inflatable","code_information":[{"code":"4273050","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273050","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":14,"gross_charge":17,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Enema Bucket Set","code_information":[{"code":"4273041","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273041","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":14,"gross_charge":16,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Oxygen Nasal Cannula High Flow","code_information":[{"code":"4273124","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273124","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":14,"gross_charge":16,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Suct Delee Trap /W Vacuum","code_information":[{"code":"4273356","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273356","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":14,"gross_charge":16,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Oxygen Spirometr Volmetrc 4000ml","code_information":[{"code":"4273985","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273985","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":14,"gross_charge":16,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Dressing Multi-trauma","code_information":[{"code":"4273804","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273804","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":14,"gross_charge":16,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Airway Oral 60mm Sz 1","code_information":[{"code":"4273456","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273456","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":14,"gross_charge":16,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Dressing Knee/island 4x10","code_information":[{"code":"4273147","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273147","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":14,"gross_charge":16,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ostomy Skin 57mm Flange","code_information":[{"code":"4273172","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273172","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Sitz Bath Disp","code_information":[{"code":"4273094","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273094","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Hematocrit","code_information":[{"code":"4300387","type":"CDM"},{"code":"305","type":"RC"},{"code":"85014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Glucose Fingerstick","code_information":[{"code":"4300371","type":"CDM"},{"code":"301","type":"RC"},{"code":"82962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Hemoglobin","code_information":[{"code":"4300386","type":"CDM"},{"code":"305","type":"RC"},{"code":"85018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Urinalysis test","code_information":[{"code":"4300719","type":"CDM"},{"code":"301","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Blood Glucose Poc","code_information":[{"code":"82962","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Urinalysis test","code_information":[{"code":"81003","type":"CDM"},{"code":"301","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Completion Of Duc 073","code_information":[{"code":"99080-73","type":"CDM"},{"code":"521","type":"RC"},{"code":"99080","type":"CPT","modifier":"73"}],"standard_charges":[{"setting":"outpatient","modifier_code":["73"],"minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oxygen Nasal Pedi Cannula","code_information":[{"code":"4273976","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273976","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Urinary Leg Bag/md","code_information":[{"code":"4273166","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273166","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Dressing Vac Y-connector","code_information":[{"code":"4273495","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273495","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":15,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Botox Type A","code_information":[{"code":"J0585","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Cast Sply Shrt Arm Cst Ped Fbgl","code_information":[{"code":"Q4012","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Splint Sply Shrt Arm Splt Adlt Fbgl","code_information":[{"code":"Q4022","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Strap Cath Holder Disp Ea.","code_information":[{"code":"A4334","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"90460 Immunization Administration With Counseling 1st Vaccine","code_information":[{"code":"90460-AM","type":"CDM"},{"code":"771","type":"RC"},{"code":"90460","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"90471 Immunization Administration; 1 Vaccine","code_information":[{"code":"90471-AM","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"90472  Each Additional Vaccine","code_information":[{"code":"90472-AM","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"90473 Immunization Administration, Oral","code_information":[{"code":"90473-AM","type":"CDM"},{"code":"771","type":"RC"},{"code":"90473","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Administer The Dose Of The Covid-19 Vaccine By Intramuscular Injection","code_information":[{"code":"90480-AM","type":"CDM"},{"code":"771","type":"RC"},{"code":"90480","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":11,"maximum":12,"gross_charge":14,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Dressing Xeroform 4x4","code_information":[{"code":"4273189","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273189","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":13,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Arm Board Short Disp","code_information":[{"code":"4273668","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273668","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":13,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Kit Cath Female 8fr Disp","code_information":[{"code":"A4353","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":13,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Cath Tray Male 14 Fr Red Rubber","code_information":[{"code":"4273017","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":13,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Tube Trach Cuff 7.5 Et","code_information":[{"code":"4273535","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273535","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Amnihook Ob Disp Ea","code_information":[{"code":"4273068","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273068","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Ostomy Skin 70mm Flang/wafer","code_information":[{"code":"4273153","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273153","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Tube Trach Cuff 7.0 Et","code_information":[{"code":"4273534","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273534","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Dexamethasone 4mg Im/i","code_information":[{"code":"J1100","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Bandage Coban 3 Ea","code_information":[{"code":"4273003","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Stopcock 3way /C Swivl Contrl","code_information":[{"code":"4273353","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273353","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Speculum Vag Med For Elec Cord Lite","code_information":[{"code":"4273619","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273619","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Speculum Vag Sm For Elec Corded Lite","code_information":[{"code":"4273620","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273620","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Dressing Duoderm 4x4ea","code_information":[{"code":"A6234","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":10,"gross_charge":12,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Biopsy Punch 3mm Disp Ea","code_information":[{"code":"4273684","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273684","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Cchd Inj Gad-base Mr Contr 1ml","code_information":[{"code":"4320100","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Tube Trach Cuff 5.0 Et","code_information":[{"code":"4273527","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273527","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Cuff 6.0 Et","code_information":[{"code":"4273531","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273531","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Cuff 8.0 Et","code_information":[{"code":"4273536","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273536","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Bandage Coban 4 Ea","code_information":[{"code":"4273170","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273170","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Oxygen Prefil Humidifier 500ml","code_information":[{"code":"4273995","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273995","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Splint Finger Curved 2.5","code_information":[{"code":"4273608","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273608","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Splint Finger Curved 3.5 Gutter","code_information":[{"code":"4273606","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273606","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Salem Sump 12fr Ea","code_information":[{"code":"4273624","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273624","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Biopsy Punch 2mm Ea","code_information":[{"code":"4273683","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273683","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Biopsy Punch 4mm Disp Ea","code_information":[{"code":"4273658","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273658","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Cuff 4.5 Et","code_information":[{"code":"4273800","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273800","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Cuff 4.0 Et","code_information":[{"code":"4273530","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273530","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Suction Cann.1200ml Disp","code_information":[{"code":"4273194","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273194","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Unc 4.0 Ea","code_information":[{"code":"4273526","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273526","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Oxygen Per Hour","code_information":[{"code":"4273982","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273982","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":9,"gross_charge":11,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Dressing Normlgel Gel 5gm","code_information":[{"code":"4273082","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273082","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Unc 2.5 Ea","code_information":[{"code":"4273523","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273523","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Collection: Capillary","code_information":[{"code":"4300006","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Dressing Adaptic 5x9 Nonadhernt","code_information":[{"code":"4273226","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273226","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Scalpel #10 Safety Sterile","code_information":[{"code":"4273096","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273096","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Scalpel #11 Safety Sterile","code_information":[{"code":"4273157","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273157","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Scalpel #15 Safety Sterile","code_information":[{"code":"4273097","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273097","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Skin Mastisol Adhesive Barrier Ampule","code_information":[{"code":"4273033","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Suture Removal Kit","code_information":[{"code":"4273086","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273086","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Injection, Triamcinolone Acetonide, Per 10mg Charge","code_information":[{"code":"J3301","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Cast Sply Sply Hnd Spica Adlt Fbgl","code_information":[{"code":"Q4014","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Splint Sply Shrt Arm Sply Ped Fbgl","code_information":[{"code":"Q4024","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Oxygen Neb /W Heater","code_information":[{"code":"4273996","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273996","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Cuff 6.5 Et","code_information":[{"code":"4273533","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273533","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Cuff 9.0 Et","code_information":[{"code":"4273538","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273538","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Splint Finger Basebll 4","code_information":[{"code":"4273266","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273266","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Splint Finger Cot 2 Inch (Fold Over)","code_information":[{"code":"4273604","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273604","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Splint Finger Cot 3 (Fold Over)","code_information":[{"code":"4273605","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273605","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Bandage Coban 2 Ea","code_information":[{"code":"4273169","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273169","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Cuff 5.5 Et","code_information":[{"code":"4273528","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273528","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tube Trach Cuff 8.5 Et","code_information":[{"code":"4273537","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273537","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Splint Nasal","code_information":[{"code":"4273938","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273938","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":9,"gross_charge":10,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Ostomy Bag/w Attched Barrier","code_information":[{"code":"4273009","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Oxygen Aersol Adlt Mask Neb Set        Tubng/mask/neb","code_information":[{"code":"4273991","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273991","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Electrode Ekg Pedi Per Pkg","code_information":[{"code":"4273698","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273698","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Pack Hot Instant","code_information":[{"code":"4273700","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273700","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Syringe Bulb/  2 Oz","code_information":[{"code":"4273593","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273593","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Nurse Visit99211","code_information":[{"code":"99211-AM","type":"CDM"},{"code":"521","type":"RC"},{"code":"99211","type":"CPT","modifier":"AM"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AM"],"minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Penrose Drain 1/4","code_information":[{"code":"4273617","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273617","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Cath Foley 12fr 5cc","code_information":[{"code":"A4338","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Oxygen Nonrebreath Pedi","code_information":[{"code":"4273864","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273864","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Cath Foley 12fr 5cc","code_information":[{"code":"4273462","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273462","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Clamp Umbilical Cord  (Disp)","code_information":[{"code":"4273295","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273295","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":9,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Cath Foley 20fr 30cc","code_information":[{"code":"4273480","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273480","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Trach Unc 4.5 Ea","code_information":[{"code":"4273112","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273112","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Trach Unc 5.0","code_information":[{"code":"4273689","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273689","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Trach Unc 6.0 Et","code_information":[{"code":"4273532","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273532","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Trach Unc 2.0","code_information":[{"code":"4273414","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273414","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Ostomy Bag 57mm Flange","code_information":[{"code":"4273174","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273174","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Steri-strip .5 X 4","code_information":[{"code":"4273323","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273323","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Trach Unc 5.5 Et","code_information":[{"code":"4273529","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273529","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Feed/stomch 5fr","code_information":[{"code":"4273520","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273520","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Trach Unc 3.5 Ea","code_information":[{"code":"4273525","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273525","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Oxygen Tube Protectr Ear Wraps","code_information":[{"code":"4273019","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Feed/stomch 8fr","code_information":[{"code":"4273522","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273522","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tube Trach Unc 3.0 Ea","code_information":[{"code":"4273524","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273524","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Albuterol 0.83% Inhalation [Pmho]","code_information":[{"code":"J7613","type":"CDM"},{"code":"250","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Atrovent 0.5mg","code_information":[{"code":"J7620","type":"CDM"},{"code":"250","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"J8499 Juvederm Ultra Xc","code_information":[{"code":"CP17667782174465450","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Cap Needle Free/ Clave Cap Ll","code_information":[{"code":"4273432","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273432","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Cath Foley 20fr 5cc","code_information":[{"code":"4273466","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273466","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Irrigation Tray W/syringe","code_information":[{"code":"4273054","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273054","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Oxygen Tubing 25ft","code_information":[{"code":"4273912","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4273912","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Ondansetron Hydrochloride, Per 1 Mg Injection","code_information":[{"code":"J2405","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":8,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Cath Foley 16 Fr 30cc","code_information":[{"code":"4273486","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273486","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Bandage Triangle 40x56","code_information":[{"code":"4273906","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273906","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Tube Connecting 10ft","code_information":[{"code":"4273143","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273143","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Splint Finger Cut-to-fit","code_information":[{"code":"4273630","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273630","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Oxygen Pedi Aresol Neblzr Mask Set","code_information":[{"code":"4273090","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273090","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Fastener Nose Tube Disp","code_information":[{"code":"4273248","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273248","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Syringe Bulb/3 Oz","code_information":[{"code":"4273594","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273594","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Nebulizer W/dragon Mask","code_information":[{"code":"A7003","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":6,"gross_charge":7,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Bandage Ace 6 Ea Roll","code_information":[{"code":"4273021","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Dressing Kerlix Gauze 3.4","code_information":[{"code":"4273061","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273061","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Arm Board Long Disp","code_information":[{"code":"4273669","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273669","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Finger Splint Static","code_information":[{"code":"Q4049","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Strainer Ua Per 2pk Disp","code_information":[{"code":"A4335","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Oxygen Nonrebreath Adult","code_information":[{"code":"4273998","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Cpap Filter Luna G3","code_information":[{"code":"4273121","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273121","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Oxygen Mask Pedi Simple","code_information":[{"code":"4273986","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273986","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Houseshoe Child /W Tread","code_information":[{"code":"4273621","type":"CDM"},{"code":"990","type":"RC"},{"code":"CP4273621","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":5,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Bandage Kling 6x85/yd","code_information":[{"code":"4273060","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Needle Huber 20g  1 In","code_information":[{"code":"4273368","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273368","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Oxygen Mask Pedi Aerosol Only (Dragon)","code_information":[{"code":"4273994","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273994","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Dressing Tegaderm 4x5","code_information":[{"code":"4273344","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273344","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Steri-strip 1/4x3","code_information":[{"code":"4273321","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273321","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Streri-strip 1/8x3","code_information":[{"code":"4273310","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273310","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Dressing Vaseline 3 X 9 Gauze","code_information":[{"code":"4273231","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273231","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Bandage Coban 1 Ea","code_information":[{"code":"4273168","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273168","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Oxygen Neblizr Hh & Tube","code_information":[{"code":"4273987","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273987","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Dressing Tegaderm W Pad","code_information":[{"code":"A6203","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Kit Skin Staple Remover","code_information":[{"code":"A4550","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Dressing Vaselin Gauz 1 X 36 In. Sterile","code_information":[{"code":"4273029","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Bandage Ace 4 Ea Roll","code_information":[{"code":"4273022","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273022","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Pack Instant Cold (Ems)","code_information":[{"code":"4273095","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273095","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":4,"gross_charge":5,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Dressing Duodrm Spot Xthn","code_information":[{"code":"4273032","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cath Plug Disp Ea","code_information":[{"code":"4273039","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273039","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Dressing 4x4 Steril  10/pk","code_information":[{"code":"4273014","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273014","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Electrode Ekg Adult","code_information":[{"code":"4273699","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273699","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Suction Yankaur Reg. Tip","code_information":[{"code":"4273081","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273081","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Oxygen Mask Adult Simple","code_information":[{"code":"4273984","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273984","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Bandage Ace 3 Ea Roll","code_information":[{"code":"4273023","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cath Female 8fr Adlt Speci Kit","code_information":[{"code":"4273040","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":3,"gross_charge":4,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Oxygen Nasal Adult Cannula","code_information":[{"code":"4273981","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273981","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cath/straight Urinary 14fr","code_information":[{"code":"4273550","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273550","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cath/straight Urinary 16fr","code_information":[{"code":"4273187","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273187","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cath/straight Urinary 8fr","code_information":[{"code":"4273548","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273548","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cath/straight Urinary 12fr","code_information":[{"code":"4273549","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273549","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cannula 02 Nasal Disp","code_information":[{"code":"A4615","type":"CDM"},{"code":"270","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Dressing Bioclusive Trnsp/ea.","code_information":[{"code":"A6257","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Dressing Combine Abd 5x9","code_information":[{"code":"A6252","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Dressing Petroleum 5x9: Xero","code_information":[{"code":"A6223","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Protective Skin Prep Wipe","code_information":[{"code":"4273020","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cath/suction/5fr","code_information":[{"code":"4273427","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273427","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Airway Oral Lg 100mm Sz 5","code_information":[{"code":"4273645","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273645","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Bandage Ace 2 Ea","code_information":[{"code":"4273024","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Dressing Adaptic  3x3","code_information":[{"code":"4273222","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273222","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Bandage Kling 4 X 75","code_information":[{"code":"4273059","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273059","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Oxygen Mask Aerosol Adult","code_information":[{"code":"4273990","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273990","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Solumedrol 40 Mg/1 Ml","code_information":[{"code":"J2919","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Bandage Kling 3x75/yd","code_information":[{"code":"4273058","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273058","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath/suction/14fr","code_information":[{"code":"4273435","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273435","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath/suction/8fr","code_information":[{"code":"4273085","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273085","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Bandage Kling 2x65/yd","code_information":[{"code":"4273057","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273057","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Dressing Tegaderm 2.37 X 2.75","code_information":[{"code":"4273126","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273126","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Mileage Emrg/tenth Ml Als","code_information":[{"code":"4533006-ET","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0425","type":"HCPCS","modifier":"ET"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ET"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Mileage Emrg/tenth Ml Bls","code_information":[{"code":"4533005-ET","type":"CDM"},{"code":"542","type":"RC"},{"code":"A0425","type":"HCPCS","modifier":"ET"}],"standard_charges":[{"setting":"outpatient","modifier_code":["ET"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Mileage Noner/tenth Als","code_information":[{"code":"4533106","type":"CDM"},{"code":"540","type":"RC"},{"code":"A0425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Mileage Noner/tenth Bls","code_information":[{"code":"4533105","type":"CDM"},{"code":"540","type":"RC"},{"code":"A0425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath/suction/12fr","code_information":[{"code":"4273434","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273434","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Bandage Kling 1x75/yd","code_information":[{"code":"4273056","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273056","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Strainer Ua Per Each","code_information":[{"code":"4273228","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273228","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath/suction/10fr","code_information":[{"code":"4273433","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273433","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath/suction/18fr","code_information":[{"code":"4273437","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273437","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Bandage Ace 4x5yd","code_information":[{"code":"A6449","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Bandage Ace 6x5yd/yd","code_information":[{"code":"A6450","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Bandage Kling 6x4.1yd/yd","code_information":[{"code":"A6447","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Dressubg Nugze Pl 1x5yd/yd","code_information":[{"code":"A6407","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Unna 3in.x10yd/yd","code_information":[{"code":"A6456","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Bite Stick Disp Ea","code_information":[{"code":"4273235","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273235","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath/suction/16fr","code_information":[{"code":"4273436","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273436","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Dressing Transparent 2 3/8 X 2.75","code_information":[{"code":"4273102","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273102","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Oxygen Tubing 7ft Extension","code_information":[{"code":"4273988","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273988","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Mileage Non Cov/tenth Mil","code_information":[{"code":"4533107","type":"CDM"},{"code":"549","type":"RC"},{"code":"A0888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Airway Oral Sm 80mm Sz 3","code_information":[{"code":"4273643","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273643","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Airway Oral 40mm Sz 00","code_information":[{"code":"4273459","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273459","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Airway Oral Md 90mm Sz 4","code_information":[{"code":"4273644","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273644","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing Abd's 8x10","code_information":[{"code":"4273016","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Medroxyprogesterone Acetate Inj","code_information":[{"code":"J1050","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing Abd's 5x9","code_information":[{"code":"4273015","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing 2x2 Sterile 2/pk","code_information":[{"code":"4273012","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing 3x3 Sterile 2/pk","code_information":[{"code":"4273013","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing 4x4 Sterl 2/pkg","code_information":[{"code":"4273106","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273106","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing Telfa 2x3 Releas","code_information":[{"code":"4273083","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273083","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing Telfa 4x3 Releas","code_information":[{"code":"4273109","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273109","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing Telfa 8x3 Releas","code_information":[{"code":"4273103","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273103","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Ostomy Bag /W 70mm Flange 2-3/4","code_information":[{"code":"4273152","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP4273152","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Pad Eye Disp Ea","code_information":[{"code":"4273025","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP4273025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Methylprednisolone Acetate Injection 40mg","code_information":[{"code":"J1010","type":"CDM"},{"code":"521","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Bandage Ace 2x5yd/yd","code_information":[{"code":"A6448","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Bandage Coban 3x5yd/yd","code_information":[{"code":"A6454","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Bandage Kling 1x75/yd","code_information":[{"code":"A6445","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Bandage Kling 3x75/yd","code_information":[{"code":"A6446","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing Telfa Releas 2x3","code_information":[{"code":"A6251","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Pad Eye Any Size Disp Ea","code_information":[{"code":"A6410","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing Guaze Kerlix 4yd/yd","code_information":[{"code":"A6441","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Dressing Gauze4x4 Ea.","code_information":[{"code":"A6402","type":"CDM"},{"code":"272","type":"RC"},{"code":"T1015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]},{"description":"Cchd Locm 300-399mg Iodn- 1ml","code_information":[{"code":"4360313","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Traditional","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield -Blue Advantage","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"UN"}}],"last_updated_on":"2025-12-26","location_name":["Castro County Hospital District dba Plains Memorial Hospital"],"hospital_address":["310 W Halsell St,  Dimmitt, TX 79027"],"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":"Elisha Rosier"},"type_2_npi":["1033118716"],"license_information":{"license_number":"000260","state":"TX"},"version":"3.0.0"}